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General NPI Number Information
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NPI Number | 1700498631
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Entity Type | Individual
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Provider Name | JACLYN JENNIFER DANG DDS
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Gender | Female
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Dates
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Enumeration Date | 08/21/2020
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Last Update Date | 08/29/2024
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Provider Practice Location Address
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Address Line | 114 MOUNT AUBURN ST
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City | CAMBRIDGE
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State | MA
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Zip | 02138-5775
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Country | US
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Telephone | 617-432-1434
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Fax |
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Provider Business Mailing Address
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Address Line | 13194 NW 23RD ST
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-2550
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Country | US
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Telephone | 910-381-6578
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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 | DN10000024
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 13103
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN25132
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License Number State | FL
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