Healthcare Provider Details

I. General information

NPI: 1700655420
Provider Name (Legal Business Name): ANH DANG DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2023
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 GA HIGHWAY 247 S
BONAIRE GA
31005-3865
US

IV. Provider business mailing address

40 COHEN WALKER DR APT 4404
KATHLEEN GA
31047-3053
US

V. Phone/Fax

Practice location:
  • Phone: 478-309-8337
  • Fax:
Mailing address:
  • Phone: 478-309-8337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN124238
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: