Provider Demographics
NPI:1104320969
Name:TSANG MOBILE DENTAL, PLLC
Entity type:Organization
Organization Name:TSANG MOBILE DENTAL, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TIGGELAAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-980-4648
Mailing Address - Street 1:5555 N LAMAR BLVD
Mailing Address - Street 2:STE H125
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751
Mailing Address - Country:US
Mailing Address - Phone:512-980-4648
Mailing Address - Fax:866-815-3719
Practice Address - Street 1:1250 S PARKER RD STE 100A
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-2178
Practice Address - Country:US
Practice Address - Phone:512-861-1337
Practice Address - Fax:866-815-3719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-19
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty