Provider Demographics
NPI:1972653764
Name:DANG, DUNG TAN
Entity Type:Individual
Prefix:DR
First Name:DUNG
Middle Name:TAN
Last Name:DANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8741N LAMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-5423
Mailing Address - Country:US
Mailing Address - Phone:512-835-2345
Mailing Address - Fax:
Practice Address - Street 1:8745 N.LAMAR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753
Practice Address - Country:US
Practice Address - Phone:512-832-6395
Practice Address - Fax:512-832-6396
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX157081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1109480Medicaid