Provider Demographics
NPI:1396970471
Name:DUDLEY M. PANG, DDS, INC.
Entity type:Organization
Organization Name:DUDLEY M. PANG, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DUDLEY
Authorized Official - Middle Name:MARVIN
Authorized Official - Last Name:PANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-499-1738
Mailing Address - Street 1:11662 LOZANO PL
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3972
Mailing Address - Country:US
Mailing Address - Phone:909-499-1738
Mailing Address - Fax:
Practice Address - Street 1:106 W ALEXANDER AVE
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-3410
Practice Address - Country:US
Practice Address - Phone:209-722-3907
Practice Address - Fax:209-383-4603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA557871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty