Provider Demographics
NPI:1457546921
Name:PANG, DUDLEY MARVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DUDLEY
Middle Name:MARVIN
Last Name:PANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
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:909-799-3848
Mailing Address - Fax:909-799-3848
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA557871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice