Healthcare Provider Details

I. General information

NPI: 1396056651
Provider Name (Legal Business Name): ANTON HOANG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2010
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 NEWBURY RD STE 150
NEWBURY PARK CA
91320-6438
US

IV. Provider business mailing address

1040 FLYNN RD
CAMARILLO CA
93012-5092
US

V. Phone/Fax

Practice location:
  • Phone: 805-498-3640
  • Fax: 805-498-3641
Mailing address:
  • Phone: 805-673-3930
  • Fax: 805-659-3217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS106873
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: