Provider Demographics
NPI:1871327973
Name:VAN DANG, D.D.S., A PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:VAN DANG, D.D.S., A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VAN
Authorized Official - Middle Name:N
Authorized Official - Last Name:DANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-381-2843
Mailing Address - Street 1:PO BOX 580668
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-0012
Mailing Address - Country:US
Mailing Address - Phone:916-688-1990
Mailing Address - Fax:916-688-5467
Practice Address - Street 1:9275 E STOCKTON BLVD STE 200
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-5067
Practice Address - Country:US
Practice Address - Phone:916-688-1990
Practice Address - Fax:916-688-5467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental