Healthcare Provider Details

I. General information

NPI: 1972438448
Provider Name (Legal Business Name): XUAN HOANG DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 W SOUTHERN AVE
MESA AZ
85210-5008
US

IV. Provider business mailing address

1225 N ARIZONA AVE UNIT 2034
GILBERT AZ
85233-1627
US

V. Phone/Fax

Practice location:
  • Phone: 602-279-5262
  • Fax:
Mailing address:
  • Phone: 347-418-7498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD012858
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: