Provider Demographics
NPI:1407051022
Name:SU VANG DDS PROF DENTAL CORP
Entity Type:Organization
Organization Name:SU VANG DDS PROF DENTAL CORP
Other - Org Name:BRITECARE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SU
Authorized Official - Middle Name:N
Authorized Official - Last Name:VANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-226-8971
Mailing Address - Street 1:3481 E SHIELDS AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726
Mailing Address - Country:US
Mailing Address - Phone:559-226-8971
Mailing Address - Fax:559-226-7924
Practice Address - Street 1:3481 E SHIELDS AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726
Practice Address - Country:US
Practice Address - Phone:559-226-8971
Practice Address - Fax:559-226-7924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA441171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty