Provider Demographics
NPI:1245327410
Name:DANG, VIET VAN (DDS)
Entity type:Individual
Prefix:
First Name:VIET
Middle Name:VAN
Last Name:DANG
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 1:1558 CONSTITUTION BLVD
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93905-3803
Mailing Address - Country:US
Mailing Address - Phone:831-449-3264
Mailing Address - Fax:831-449-1338
Practice Address - Street 1:1558 CONSTITUTION BOULEVARD
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93905
Practice Address - Country:US
Practice Address - Phone:831-449-3264
Practice Address - Fax:831-449-1338
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA487991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB47899-01OtherHEALTY FAMILIES
CAG93190-01OtherDENTICAL