1386923811 NPI number — DR. JACKILYN DANG DMD

Table of content: DR. JACKILYN DANG DMD (NPI 1386923811)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386923811 NPI number — DR. JACKILYN DANG DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DANG
Provider First Name:
JACKILYN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386923811
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3851 SW GREEN OAKS BLVD
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76017-4130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-789-4488
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3851 SW GREEN OAKS BLVD
Provider Second Line Business Practice Location Address:
#100
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76017-4130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-789-4488
Provider Business Practice Location Address Fax Number:
817-541-4471
Provider Enumeration Date:
08/15/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  27231 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 27231 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 282677802 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 800851489 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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