Healthcare Provider Details

I. General information

NPI: 1811397383
Provider Name (Legal Business Name): DENTABLISS DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2014
Last Update Date: 10/29/2015
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: 925-391-0091
  • Fax:
Mailing address:
  • Phone: 925-391-0091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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