Healthcare Provider Details

I. General information

NPI: 1902662687
Provider Name (Legal Business Name): DUC TANG DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2024
Last Update Date: 02/21/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10844 PROVIDENCE RD SUITE 270
CHARLOTTE NC
28277
US

IV. Provider business mailing address

10844 PROVIDENCE RD SUITE 270
CHARLOTTE NC
28277
US

V. Phone/Fax

Practice location:
  • Phone: 704-321-0980
  • Fax: 704-321-0712
Mailing address:
  • Phone: 704-321-0980
  • Fax: 704-321-0712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DUC TANG
Title or Position: DOCTOR/OWNER
Credential: DDS
Phone: 704-321-0980