Provider Demographics
NPI:1154784395
Name:PETER K. PANG D.D.S., P.A.
Entity type:Organization
Organization Name:PETER K. PANG D.D.S., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORPORATE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:828-274-3882
Mailing Address - Street 1:10A YORKSHIRE ST
Mailing Address - Street 2:SUITE #B
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2758
Mailing Address - Country:US
Mailing Address - Phone:828-274-3882
Mailing Address - Fax:828-274-9589
Practice Address - Street 1:10A YORKSHIRE ST
Practice Address - Street 2:SUITE #B
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2758
Practice Address - Country:US
Practice Address - Phone:828-274-3882
Practice Address - Fax:828-274-9589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10204122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty