Provider Demographics
NPI:1679735369
Name:DANG, PRITAM S (DDS)
Entity type:Individual
Prefix:
First Name:PRITAM
Middle Name:S
Last Name:DANG
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 1:840 SUMMIT ST STE K
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-4300
Mailing Address - Country:US
Mailing Address - Phone:847-289-9900
Mailing Address - Fax:847-289-0798
Practice Address - Street 1:840 SUMMIT ST STE K
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-4300
Practice Address - Country:US
Practice Address - Phone:847-289-9900
Practice Address - Fax:847-289-0798
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019023793122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist