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Organization
SOPHEAP TANG DMD DENTAL CORPORATION
Active
Organization
SOPHEAP TANG DMD DENTAL CORPORATION
Active
Parent organization
SOPHEAP TANG DMD DENTAL CORPORATION
Other names
A Tooth Fairy Dental Office of Sopheap Tang, DMD
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOPHEAP TANG DMD DENTAL CORPORATION
Authorized official
DR. SOPHEAP TANG DMD (PRESIDENT)
(951) 789-0200
Entity
Organization
Contact information
Practice address
18876 VAN BUREN BLVD, 107, RIVERSIDE, CA 92508
(951) 789-0200
(951) 789-0245
Mailing address
18876 VAN BUREN BLVD, 107, RIVERSIDE, CA 92508
(951) 789-0200
(951) 789-0245
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
56393
CA
1223G0001X
General Practice Dentistry
57844
CA
1223P0221X
Pediatric Dentistry
58240
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255523593
—
CA
Enumeration date
08/09/2011
Last updated
04/23/2020
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