Healthcare Provider Details

I. General information

NPI: 1760779326
Provider Name (Legal Business Name): GEORGE DA-CHANG HWANG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2011
Last Update Date: 05/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MDG/SGIC
TRAVIS AFB CA
94533
US

IV. Provider business mailing address

DENTAL CLINIC, DAVID GRANT MEDICAL CENTER 101 BODIN CIR
TRAVIS AFB CA
94535-1809
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-7001
  • Fax:
Mailing address:
  • Phone: 707-423-3040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number60465
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: