Healthcare Provider Details

I. General information

NPI: 1124563119
Provider Name (Legal Business Name): CHERI A DANG DMD 2 INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2016
Last Update Date: 12/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 DEERWOOD RD SUITE 170
SAN RAMON CA
94583-4409
US

IV. Provider business mailing address

111 DEERWOOD RD SUITE 170
SAN RAMON CA
94583-4409
US

V. Phone/Fax

Practice location:
  • Phone: 818-800-4868
  • Fax: 925-270-0636
Mailing address:
  • Phone: 925-391-0091
  • Fax: 925-270-0636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number1495
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number58382
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number58382
License Number StateCA

VIII. Authorized Official

Name: CHERI DANG
Title or Position: OWNER/PRESIDENT
Credential: DMD
Phone: 818-800-4868