MEDICARE: DR. DERICK DANG DO 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	122300000X	Dentist	20355	TX

General Provider Information

NPI Number	:	1912047135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DERICK DANG DO D.D.S.

Provider Business Mailing Address
First Line	:	6306 GULFTON ST
Second Line	:	SUITE #201
City	:	HOUSTON
State	:	TX
Zip	:	77081-1117
Country	:	US
Telephone Number	:	713-541-3013
Fax Number	:

Provider Business Practice Location Address
First Line	:	6306 GULFTON ST
Second Line	:	SUITE# 201
City	:	HOUSTON
State	:	TX
Zip	:	77081-1108
Country	:	US
Telephone Number	:	713-541-3013
Fax Number	:

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	09/18/2013

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