Provider Demographics
NPI:1346558269
Name:PANG, ALAN W (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:W
Last Name:PANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6651 CHIPPEWA ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-4106
Mailing Address - Country:US
Mailing Address - Phone:314-351-9299
Mailing Address - Fax:314-351-1680
Practice Address - Street 1:6651 CHIPPEWA ST
Practice Address - Street 2:SUITE 212
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-4106
Practice Address - Country:US
Practice Address - Phone:314-351-9299
Practice Address - Fax:314-351-1680
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO138001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice