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General NPI Number Information
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NPI Number | 1548471444
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Entity Type | Individual
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Provider Name | VERA W. L. TANG D.D.S., M.S.
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Gender | Female
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1097 OLD COUNTRY RD SUITE 206
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City | PLAINVIEW
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State | NY
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Zip | 11803-6505
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Country | US
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Telephone | 516-681-9500
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Fax |
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Provider Business Mailing Address
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Address Line | 94-01 FRANCIS LEWIS BLVD.
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City | QUEENS VILLAGE
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State | NY
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Zip | 11428-1517
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Country | US
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Telephone | 718-740-8257
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 0502401
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License Number State | NY
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