Healthcare Provider Details

I. General information

NPI: 1083438048
Provider Name (Legal Business Name): YAT T. TANG, DDS, MS, PHD, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/14/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 19TH ST S STE 102
SARTELL MN
56377-2570
US

IV. Provider business mailing address

325 19TH ST S STE 102
SARTELL MN
56377-2570
US

V. Phone/Fax

Practice location:
  • Phone: 626-863-5724
  • Fax:
Mailing address:
  • Phone: 626-863-5724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. YAT T TANG
Title or Position: PRESIDENT
Credential: DDS, MS, PHD
Phone: 626-863-5724