MEDICARE: TANG SAHARA MODERN DENTISTRY, PC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1124603832
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TANG SAHARA MODERN DENTISTRY, PC

Provider Business Mailing Address
First Line	:	17000 RED HILL AVE
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92614-5626
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4950 W. SAHARA AVE
Second Line	:	SUITE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89146
Country	:	US
Telephone Number	:	702-680-1525
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHENG TANG
Credential	:
Telephone Number	:	714-845-8231

Provider Enumeration Date	:	03/15/2021
Last Update Date	:	03/15/2021

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