| NPI | 1255610242 |
|---|---|
| Doing Business As | A TOOTH FAIRY DENTAL OFFICE OF SOPHEAP TANG, DMD |
| Entity Type | Organization |
| Authorized Contact | SOPHEAP TANG President 951-789-0200 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 56393) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 57844) |
| 1223P0221X Dentist Pediatric Dentistry (Licence: CA 58240) | |
| Enumeration Date | 2011-08-09 |
| Last Update Date | 2020-04-23 |