Provider Demographics
NPI:1124178298
Name:VANG, JOSHUA TOM (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:TOM
Last Name:VANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:374 ANNAPOLIS ST W
Mailing Address - Street 2:
Mailing Address - City:WEST ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-1107
Mailing Address - Country:US
Mailing Address - Phone:651-457-6231
Mailing Address - Fax:651-457-8008
Practice Address - Street 1:374 ANNAPOLIS ST W
Practice Address - Street 2:
Practice Address - City:WEST ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-1107
Practice Address - Country:US
Practice Address - Phone:651-457-6231
Practice Address - Fax:651-457-8008
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND123301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice