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General NPI Number Information
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NPI Number | 1811397383
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Entity Type | Organization
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Legal Business Name | DENTABLISS DENTAL
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Dates
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Enumeration Date | 09/03/2014
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Last Update Date | 10/29/2015
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Provider Practice Location Address
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Address Line | 111 DEERWOOD RD SUITE 170
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City | SAN RAMON
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State | CA
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Zip | 94583-4409
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Country | US
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Telephone | 925-391-0091
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Fax |
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Provider Business Mailing Address
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Address Line | 111 DEERWOOD RD SUITE 170
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City | SAN RAMON
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State | CA
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Zip | 94583-4409
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Country | US
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Telephone | 925-391-0091
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. CHERI A DANG
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Credential |
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Telephone | 818-800-4868
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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 | 58382
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | 58382
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License Number State | CA
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