Provider Demographics
NPI:1982730594
Name:CHIANG, TAT FAI (DMD)
Entity type:Individual
Prefix:DR
First Name:TAT
Middle Name:FAI
Last Name:CHIANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 N GASTON AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-2434
Mailing Address - Country:US
Mailing Address - Phone:908-218-0770
Mailing Address - Fax:908-218-9789
Practice Address - Street 1:10 N GASTON AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2434
Practice Address - Country:US
Practice Address - Phone:908-218-0770
Practice Address - Fax:908-218-9789
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI013593001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics