Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223X0400X | Orthodontists | 30175 | TX |
Y | 1223X0400X | Orthodontists | 8404 | NC |
NPI | 1003019845 |
---|---|
Provider Name | Dr. Dana Thi Tang |
First Address | Minneapolis, MN 55486-0036 |
Second Address | Fayetteville, NC 28306-8349 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2007 |
Last Update Date | 09/11/2016 |