=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982123279
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DANG AND GILL DENTAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2017
-----------------------------------------------------
Last Update Date | 03/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8204 DELTA SHORES CIR S STE 140
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95832-9101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-277-9069
-----------------------------------------------------
Fax | 916-273-3027
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 920050
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75392-0050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-845-8500
-----------------------------------------------------
Fax | 303-952-0892
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | AVALPREET DANG
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 916-277-9069
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------