Provider Demographics
NPI:1386867679
Name:TANG, THOMAS T (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:T
Last Name:TANG
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 1:17185 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4428
Mailing Address - Country:US
Mailing Address - Phone:262-821-1000
Mailing Address - Fax:262-821-5004
Practice Address - Street 1:17185 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4428
Practice Address - Country:US
Practice Address - Phone:262-821-1000
Practice Address - Fax:262-821-5004
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI38011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3801OtherSTATE LICENSE