Healthcare Provider Details

I. General information

NPI: 1821917196
Provider Name (Legal Business Name): WILLIAM DUY-DAT TON-THAT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 TRIPOLI AVE FL 2
SAN DIEGO CA
92140-5290
US

IV. Provider business mailing address

12908 LORIEN WAY
OKLAHOMA CITY OK
73170-0404
US

V. Phone/Fax

Practice location:
  • Phone: 161-952-4400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8223
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: