MEDICARE: DR. ERWIN E TANG D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	13817	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	13817	OTHER	TX	DENTAL STATE LICENSE #

General Provider Information

NPI Number	:	1205830718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERWIN E TANG D.D.S.

Provider Business Mailing Address
First Line	:	14465 WEBB CHAPEL RD
Second Line	:	STE 103
City	:	FARMERS BRANCH
State	:	TX
Zip	:	75234-3600
Country	:	US
Telephone Number	:	972-241-8733
Fax Number	:

Provider Business Practice Location Address
First Line	:	THE ATRUIM PROFESSIONAL BUILDING
Second Line	:	14465 WEBB CHAPEL RD. SUITE 103
City	:	FARMERS BRANCH
State	:	TX
Zip	:	75234-3600
Country	:	US
Telephone Number	:	972-241-8733
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	07/08/2007

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