Healthcare Provider Details

I. General information

NPI: 1023563939
Provider Name (Legal Business Name): HOANG DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2016
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4750 OCEANSIDE BLVD STE A15
OCEANSIDE CA
92056-3064
US

IV. Provider business mailing address

1356 W VALLEY PKWY
ESCONDIDO CA
92029-2299
US

V. Phone/Fax

Practice location:
  • Phone: 760-466-0776
  • Fax:
Mailing address:
  • Phone: 760-233-5887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number47626
License Number StateCA

VIII. Authorized Official

Name: DR. ANDY TRONG HOANG
Title or Position: PRESIDENT
Credential: DDS
Phone: 760-233-5887