Provider Demographics
NPI:1952507725
Name:MINH DANG DENTAL CORPORATION
Entity Type:Organization
Organization Name:MINH DANG DENTAL CORPORATION
Other - Org Name:SOUTH VALLEY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MINH
Authorized Official - Middle Name:PV
Authorized Official - Last Name:DANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-778-6684
Mailing Address - Street 1:15870 MONTEREY ST
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-5475
Mailing Address - Country:US
Mailing Address - Phone:408-778-6684
Mailing Address - Fax:408-778-6698
Practice Address - Street 1:15870 MONTEREY ST
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-5475
Practice Address - Country:US
Practice Address - Phone:408-778-6684
Practice Address - Fax:408-778-6698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2007-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA461751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB46175Medicare ID - Type Unspecified