MEDICARE: NANCY LINH HA DDS

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	261QD0000X	Dental Clinic/Center	4713	AR
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	4713	AR

General Provider Information

NPI Number	:	1679341911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY LINH HA DDS

Provider Business Mailing Address
First Line	:	11775 GILES RD
Second Line	:
City	:	FARMINGTON
State	:	AR
Zip	:	72730-9650
Country	:	US
Telephone Number	:	918-360-3773
Fax Number	:

Provider Business Practice Location Address
First Line	:	4605 PHOENIX AVE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-6007
Country	:	US
Telephone Number	:	479-250-4531
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2023
Last Update Date	:	12/15/2023

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