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General NPI Number Information
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NPI Number | 1376747683
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Entity Type | Individual
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Provider Name | BAO-HANH THI DANG DDS
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Gender | Female
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Dates
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Enumeration Date | 06/12/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4417 W GORE BLVD STE 11
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City | LAWTON
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State | OK
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Zip | 73505-5978
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Country | US
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Telephone | 580-248-8418
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Fax |
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Provider Business Mailing Address
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Address Line | 4413 S LEE AVE
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City | OKLAHOMA CITY
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State | OK
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Zip | 73109-3527
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Country | US
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Telephone | 405-631-7748
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5945
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License Number State | OK
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