Healthcare Provider Details

I. General information

NPI: 1801988035
Provider Name (Legal Business Name): HOANG DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 W FELICITA AVE
ESCONDIDO CA
92025-6517
US

IV. Provider business mailing address

26273 PALM TREE LN
MURRIETA CA
92563-7302
US

V. Phone/Fax

Practice location:
  • Phone: 760-233-2260
  • Fax:
Mailing address:
  • Phone: 714-943-5364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number47626
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDY T HOANG
Title or Position: OWNER DDS
Credential: DDS
Phone: 760-233-2260