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General NPI Number Information
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NPI Number | 1871668830
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Entity Type | Organization
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Legal Business Name | VANG DENTAL CLINIC, INC
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 08/02/2007
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Provider Practice Location Address
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Address Line | 365 UNIVERSITY AVE W
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City | SAINT PAUL
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State | MN
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Zip | 55103-2018
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Country | US
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Telephone | 651-222-6738
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Fax | 651-848-0808
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Provider Business Mailing Address
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Address Line | 365 UNIVERSITY AVE W
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City | SAINT PAUL
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State | MN
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Zip | 55103-2018
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Country | US
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Telephone | 651-222-6738
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Fax | 651-848-0808
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. PETE VANG
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Credential |
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Telephone | 651-222-6738
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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 | 11210
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License Number State | MN
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