Provider Demographics
NPI:1063583821
Name:TANG, TRUNG MINH (DMD)
Entity type:Individual
Prefix:DR
First Name:TRUNG
Middle Name:MINH
Last Name:TANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 N GALLOWAY AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-5713
Mailing Address - Country:US
Mailing Address - Phone:972-216-0300
Mailing Address - Fax:972-216-0700
Practice Address - Street 1:2110 N GALLOWAY AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-5713
Practice Address - Country:US
Practice Address - Phone:972-216-0300
Practice Address - Fax:972-216-0700
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX219391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice