Provider Demographics
NPI:1760115422
Name:DANG, NOLAN T (DDS)
Entity Type:Individual
Prefix:
First Name:NOLAN
Middle Name:T
Last Name:DANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2375 40TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-2147
Mailing Address - Country:US
Mailing Address - Phone:415-490-6368
Mailing Address - Fax:
Practice Address - Street 1:32700 ALVARADO BLVD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94555-1202
Practice Address - Country:US
Practice Address - Phone:510-477-0811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-08
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109203122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist