Provider Demographics
NPI:1306828926
Name:DANG, TIFFANY (DMD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:
Last Name:DANG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 LAKE MEDLOCK DR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-5673
Mailing Address - Country:US
Mailing Address - Phone:770-622-7862
Mailing Address - Fax:
Practice Address - Street 1:5456 JIMMY CARTER BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-1543
Practice Address - Country:US
Practice Address - Phone:770-441-0808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11501122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist