MEDICARE: TANGWAN NGANTEH DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	2025030771	MO
2	390200000X	Student in an Organized Health Care Education/Training Program
3	1223G0001X	General Practice Dentistry	DEN2000285	DC

General Provider Information

NPI Number	:	1104519362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANGWAN NGANTEH DDS

Provider Business Mailing Address
First Line	:	1 CARDINAL WAY
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63102-2806
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2231 MICHIGAN AVE
Second Line	:
City	:	ARNOLD
State	:	MO
Zip	:	63010-2151
Country	:	US
Telephone Number	:	636-287-6603
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2023
Last Update Date	:	12/12/2025

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Directions to “ TANGWAN NGANTEH DDS” Practice Location

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