Provider Demographics
NPI:1356232359
Name:DANG, TAI (DMD, RN)
Entity type:Individual
Prefix:
First Name:TAI
Middle Name:
Last Name:DANG
Suffix:
Gender:M
Credentials:DMD, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 TRUMBAUER WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-7434
Mailing Address - Country:US
Mailing Address - Phone:510-586-8660
Mailing Address - Fax:
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:
Is Sole Proprietor?:No
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1119541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice