Provider Demographics
NPI:1457961377
Name:NGO, TAN (DDS)
Entity Type:Individual
Prefix:
First Name:TAN
Middle Name:
Last Name:NGO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5941 FM 2920 RD STE B
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-3542
Mailing Address - Country:US
Mailing Address - Phone:281-288-8860
Mailing Address - Fax:
Practice Address - Street 1:5941 FM 2920 RD STE B
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-3542
Practice Address - Country:US
Practice Address - Phone:281-288-8860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX364941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice