MEDICARE: DANE HOANG DDS MS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry		TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073873139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANE HOANG DDS MS PA

Provider Business Mailing Address
First Line	:	8900 FOREST LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-4113
Country	:	US
Telephone Number	:	972-234-4500
Fax Number	:

Provider Business Practice Location Address
First Line	:	8900 FOREST LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-4113
Country	:	US
Telephone Number	:	972-234-4500
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS ASSISTANT
Name	:	YURI VEGA
Credential	:
Telephone Number	:	972-234-4500

Provider Enumeration Date	:	05/23/2012
Last Update Date	:	05/23/2012

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