MEDICARE: DIANA DANG DMD

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	122300000X	Dentist	101883	CA

General Provider Information

NPI Number	:	1881112993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA DANG DMD

Provider Business Mailing Address
First Line	:	25590 PROSPECT AVE APT 12F
Second Line	:
City	:	LOMA LINDA
State	:	CA
Zip	:	92354-3145
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13792 BEAR VALLEY RD # 1
Second Line	:
City	:	VICTORVILLE
State	:	CA
Zip	:	92392-8713
Country	:	US
Telephone Number	:	760-245-2010
Fax Number	:

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

Provider Enumeration Date	:	09/08/2017
Last Update Date	:	09/08/2017

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