Provider Demographics
NPI:1912047135
Name:DO, DERICK DANG (DDS)
Entity type:Individual
Prefix:DR
First Name:DERICK
Middle Name:DANG
Last Name:DO
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 1:6306 GULFTON ST
Mailing Address - Street 2:SUITE #201
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-1117
Mailing Address - Country:US
Mailing Address - Phone:713-541-3013
Mailing Address - Fax:
Practice Address - Street 1:6306 GULFTON ST
Practice Address - Street 2:SUITE# 201
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-1108
Practice Address - Country:US
Practice Address - Phone:713-541-3013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20355122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist