Provider Demographics
NPI:1366052482
Name:ZHANG, TONY KAILI (DDS)
Entity type:Individual
Prefix:DR
First Name:TONY
Middle Name:KAILI
Last Name:ZHANG
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 1:11670 GOODHUE ST NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-4653
Mailing Address - Country:US
Mailing Address - Phone:281-818-0926
Mailing Address - Fax:
Practice Address - Street 1:110 OPPORTUNITY BLVD S STE A
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-2222
Practice Address - Country:US
Practice Address - Phone:716-331-0120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX362401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty