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General NPI Number Information
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NPI Number | 1396970471
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Entity Type | Organization
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Legal Business Name | DUDLEY M. PANG, DDS, INC.
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Dates
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Enumeration Date | 05/19/2009
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Last Update Date | 05/19/2009
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Provider Practice Location Address
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Address Line | 106 W ALEXANDER AVE
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City | MERCED
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State | CA
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Zip | 95348-3410
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Country | US
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Telephone | 209-722-3907
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Fax | 209-383-4603
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Provider Business Mailing Address
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Address Line | 11662 LOZANO PL
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City | LOMA LINDA
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State | CA
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Zip | 92354-3972
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Country | US
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Telephone | 909-499-1738
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. DUDLEY MARVIN PANG
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Credential | DDS
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Telephone | 909-499-1738
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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 | 55787
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License Number State | CA
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