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General NPI Number Information
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NPI Number | 1790271781
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Entity Type | Individual
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Provider Name | TIFFANY TANG DMD
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Gender | Female
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Dates
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Enumeration Date | 07/02/2018
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Last Update Date | 07/02/2018
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Provider Practice Location Address
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Address Line | 955 PARK AVE N STE D
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City | RENTON
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State | WA
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Zip | 98057-5680
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Country | US
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Telephone | 425-793-6003
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Fax |
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Provider Business Mailing Address
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Address Line | 15755 NE 100TH WAY
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City | REDMOND
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State | WA
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Zip | 98052-1002
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Country | US
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Telephone | 954-496-1056
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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 | 60851040
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License Number State | WA
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