Provider Demographics
NPI:1609523349
Name:DANG, TAM THANH THI (RDH)
Entity Type:Individual
Prefix:
First Name:TAM
Middle Name:THANH THI
Last Name:DANG
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 CENTRE AVE # 2
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-2313
Mailing Address - Country:US
Mailing Address - Phone:781-363-2762
Mailing Address - Fax:
Practice Address - Street 1:1470 DORCHESTER AVE
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-1344
Practice Address - Country:US
Practice Address - Phone:617-379-3600
Practice Address - Fax:617-379-3555
Is Sole Proprietor?:No
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADH90501124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist