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Individual

DR. PETER SUCHOL JANG

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.D.S.

Contact information

Practice address
3161 HIGHWAY 64, SUITE 400, EADS, TN 38028-3021
(901) 813-8476
(901) 813-8479
Mailing address
3161 HIGHWAY 64, SUITE 400, EADS, TN 38028-3021
(901) 813-8476
(901) 813-8479

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
DS 8164
TN
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
3601
AR
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DS 8164
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
5440084
TN
Enumeration date
03/27/2006
Last updated
05/11/2011
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