Provider Demographics
NPI:1467663203
Name:PHANG, ROBERT MING (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MING
Last Name:PHANG
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 1:16201 OCEANVIEW DR
Mailing Address - Street 2:P.O. BOX 964
Mailing Address - City:SMITH RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95567-9318
Mailing Address - Country:US
Mailing Address - Phone:707-465-1000
Mailing Address - Fax:
Practice Address - Street 1:5905 LAKE EARL DRIVE
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531
Practice Address - Country:US
Practice Address - Phone:707-465-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28065122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist