Provider Demographics
NPI:1437284114
Name:TANG, LINDA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:
Last Name:TANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5930 W GREENWAY RD
Mailing Address - Street 2:#14A
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-3200
Mailing Address - Country:US
Mailing Address - Phone:602-978-4621
Mailing Address - Fax:
Practice Address - Street 1:5930 W GREENWAY RD
Practice Address - Street 2:#14A
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-3200
Practice Address - Country:US
Practice Address - Phone:602-978-4621
Practice Address - Fax:602-978-4375
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ65991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ964256Medicaid