Provider Demographics
NPI:1821083981
Name:GANG, HERMAN EDWIN (DDS)
Entity Type:Individual
Prefix:
First Name:HERMAN
Middle Name:EDWIN
Last Name:GANG
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 1:109 ALLAMUCHY RD
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07821-5511
Mailing Address - Country:US
Mailing Address - Phone:973-786-5588
Mailing Address - Fax:973-786-7820
Practice Address - Street 1:8 LENAPE RD
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:NJ
Practice Address - Zip Code:07821-4568
Practice Address - Country:US
Practice Address - Phone:973-786-5588
Practice Address - Fax:978-786-7820
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-15
Last Update Date:2007-07-08
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-17
Provider Licenses
StateLicense IDTaxonomies
NJ83951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice