Provider Demographics
NPI:1831127687
Name:DANG, T. KEVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:T.
Middle Name:KEVIN
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 1:10315 19TH AVE SE
Mailing Address - Street 2:STE 102
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-4259
Mailing Address - Country:US
Mailing Address - Phone:425-385-3170
Mailing Address - Fax:425-385-3907
Practice Address - Street 1:10315 19TH AVE SE
Practice Address - Street 2:STE 102
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-4259
Practice Address - Country:US
Practice Address - Phone:425-385-3170
Practice Address - Fax:425-385-3907
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 88051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5034368Medicaid