Provider Demographics
NPI:1316618952
Name:TAN, DANIEL JIAN MING (BDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JIAN MING
Last Name:TAN
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5120 W LOVERS LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75209-3332
Mailing Address - Country:US
Mailing Address - Phone:214-956-9100
Mailing Address - Fax:214-956-9169
Practice Address - Street 1:5120 W LOVERS LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75209-3332
Practice Address - Country:US
Practice Address - Phone:214-956-9100
Practice Address - Fax:214-956-9169
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX369891223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics