Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 21045 | MA |
NPI | 1144254699 |
---|---|
Provider Name | Dr. Alan Thanh Tang |
First Address | Malden, MA 02148-5655 |
Second Address | Framingham, MA 01701-4648 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0205010 | MASS HEALTH (01) | MA |