MEDICARE: NOLAN T DANG DDS

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	122300000X	Dentist	109203	CA

General Provider Information

NPI Number	:	1760115422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOLAN T DANG DDS

Provider Business Mailing Address
First Line	:	2375 40TH AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94116-2147
Country	:	US
Telephone Number	:	415-490-6368
Fax Number	:

Provider Business Practice Location Address
First Line	:	32700 ALVARADO BLVD
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94555-1202
Country	:	US
Telephone Number	:	510-477-0811
Fax Number	:

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

Provider Enumeration Date	:	07/08/2022
Last Update Date	:	09/19/2023

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