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NPI Code Detail

MEDICARE: MS. LAN-TU DANG HOLEM D.D.S.

MEDICARE: MS. LAN-TU DANG HOLEM D.D.S.
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
11223G0001XGeneral Practice Dentistry014975MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21902892235OTHERMONATIONAL PROVIDER IDENTIF

General Provider Information

NPI Number : 1902892235
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LAN-TU DANG HOLEM D.D.S.
Provider Business Mailing Address
First Line : 340 KELLEY PKWY
Second Line :
City : MEXICO
State : MO
Zip : 65265-3811
Country : US
Telephone Number : 573-582-1234
Fax Number : 573-582-1212
Provider Business Practice Location Address
First Line : 340 KELLEY PKWY
Second Line :
City : MEXICO
State : MO
Zip : 65265-3811
Country : US
Telephone Number : 573-582-1234
Fax Number : 573-582-1212
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2005
Last Update Date : 03/10/2020

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Directions to “ MS. LAN-TU DANG HOLEM D.D.S.” Practice Location

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