Provider Demographics
NPI:1053330415
Name:PANG, PETER K (DDS)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:K
Last Name:PANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 3RD ST W
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-6502
Mailing Address - Country:US
Mailing Address - Phone:707-996-3016
Mailing Address - Fax:707-996-2877
Practice Address - Street 1:10A YORKSHIRE STREET
Practice Address - Street 2:SUITE B
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2774
Practice Address - Country:US
Practice Address - Phone:828-274-3882
Practice Address - Fax:707-996-2877
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2024-10-22
Deactivation Date:2024-10-13
Deactivation Code:
Reactivation Date:2024-10-21
Provider Licenses
StateLicense IDTaxonomies
NC102041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice