| A Tooth Fairy Dental Office Of Sopheap Tang, Dmd | |
|
18876 Van Buren Blvd 107 Riverside CA 92508 | |
| (951) 789-0200 | |
| (951) 789-0245 |
| Full Name | A Tooth Fairy Dental Office Of Sopheap Tang, Dmd |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 18876 Van Buren Blvd, Riverside, California |
| Authorized Official Name and Position | Sopheap Tang (PRESIDENT) |
| Authorized Official Contact | 9517890200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| A Tooth Fairy Dental Office Of Sopheap Tang, Dmd 18876 Van Buren Blvd 107 Riverside CA 92508 Ph: (951) 789-0200 | A Tooth Fairy Dental Office Of Sopheap Tang, Dmd 18876 Van Buren Blvd 107 Riverside CA 92508 Ph: (951) 789-0200 |
| NPI Number | 1255610242 |
|---|---|
| Provider Enumeration Date | 08/09/2011 |
| Last Update Date | 04/23/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255610242 | NPI | - | NPPES |
| 1255523593 | Medicaid | CA |
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