Provider Demographics
NPI:1437584596
Name:DANG, AN T (RDH, BA)
Entity Type:Individual
Prefix:MR
First Name:AN
Middle Name:T
Last Name:DANG
Suffix:
Gender:M
Credentials:RDH, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 S M ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98418-3933
Mailing Address - Country:US
Mailing Address - Phone:253-476-8003
Mailing Address - Fax:253-476-8004
Practice Address - Street 1:3815 S M ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98418-3933
Practice Address - Country:US
Practice Address - Phone:253-476-8003
Practice Address - Fax:253-476-8004
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH60371073124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist