Provider Demographics
NPI:1902178312
Name:DANG, MINH TAM THI (DDS)
Entity Type:Individual
Prefix:DR
First Name:MINH TAM
Middle Name:THI
Last Name:DANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4619 AMERICAN RIVER DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-6105
Mailing Address - Country:US
Mailing Address - Phone:916-974-0270
Mailing Address - Fax:
Practice Address - Street 1:4136 E COMMERCE WAY STE 100
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-9685
Practice Address - Country:US
Practice Address - Phone:916-483-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA330751223G0001X
VA04010068761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice