Provider Demographics
NPI:1144254699
Name:TANG, ALAN THANH (DDS, CAGS)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:THANH
Last Name:TANG
Suffix:
Gender:M
Credentials:DDS, CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 LINWOOD ST APT 301
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-5655
Mailing Address - Country:US
Mailing Address - Phone:617-875-7708
Mailing Address - Fax:
Practice Address - Street 1:405 COCHITUATE RD STE 304
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-4648
Practice Address - Country:US
Practice Address - Phone:508-424-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA210451223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0205010OtherMASS HEALTH