Provider Demographics
NPI:1275080376
Name:NG, DEREK (DDS)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:NG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 E CHAPEL ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4522
Mailing Address - Country:US
Mailing Address - Phone:805-928-0363
Mailing Address - Fax:805-928-1149
Practice Address - Street 1:610 E CHAPEL ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4522
Practice Address - Country:US
Practice Address - Phone:805-928-0363
Practice Address - Fax:805-928-1149
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100821122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist