Provider Demographics
NPI:1336356856
Name:DANG, QUYEN T (DDS)
Entity Type:Individual
Prefix:DR
First Name:QUYEN
Middle Name:T
Last Name:DANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CENTER DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1525
Mailing Address - Country:US
Mailing Address - Phone:847-968-2220
Mailing Address - Fax:
Practice Address - Street 1:300 CENTER DR
Practice Address - Street 2:SUITE 106
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1525
Practice Address - Country:US
Practice Address - Phone:847-968-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190234381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9185078Medicaid