Provider Demographics
NPI:1083438048
Name:YAT T. TANG, DDS, MS, PHD, P.C.
Entity type:Organization
Organization Name:YAT T. TANG, DDS, MS, PHD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YAT
Authorized Official - Middle Name:T
Authorized Official - Last Name:TANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS, PHD
Authorized Official - Phone:626-863-5724
Mailing Address - Street 1:325 19TH ST S STE 102
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-2570
Mailing Address - Country:US
Mailing Address - Phone:626-863-5724
Mailing Address - Fax:
Practice Address - Street 1:325 19TH ST S STE 102
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-2570
Practice Address - Country:US
Practice Address - Phone:626-863-5724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty