Provider Demographics
NPI:1942617378
Name:TANG, JEFFREY (DDS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:TANG
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 1:12620 WOODFOREST BLVD
Mailing Address - Street 2:#420A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-3489
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12620 WOODFOREST BLVD
Practice Address - Street 2:#420A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-3489
Practice Address - Country:US
Practice Address - Phone:713-637-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX301271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice