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General NPI Number Information
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NPI Number | 1619540135
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Entity Type | Individual
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Provider Name | ALLEN CLARK TANG DMD
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Gender | Male
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Dates
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Enumeration Date | 07/22/2021
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Last Update Date | 07/22/2021
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Provider Practice Location Address
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Address Line | 366 W LAKE MEAD PKWY STE 100
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City | HENDERSON
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State | NV
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Zip | 89015-7287
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Country | US
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Telephone | 702-464-3090
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Fax |
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Provider Business Mailing Address
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Address Line | 10650 DEAN MARTIN DR UNIT 120
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City | LAS VEGAS
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State | NV
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Zip | 89141-3581
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Country | US
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Telephone | 602-214-2541
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 7528
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License Number State | NV
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