Provider Demographics
NPI:1639625213
Name:TANG, THANH (DMD)
Entity Type:Individual
Prefix:
First Name:THANH
Middle Name:
Last Name:TANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4162 AZALEA CREST WALK
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-3912
Mailing Address - Country:US
Mailing Address - Phone:678-907-7288
Mailing Address - Fax:
Practice Address - Street 1:4162 AZALEA CREST WALK
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-3912
Practice Address - Country:US
Practice Address - Phone:678-907-7288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9743122300000X
GADN122252122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist