Healthcare Provider Details

I. General information

NPI: 1720702053
Provider Name (Legal Business Name): ANTHONY MACH HUA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2022
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 WALNUT AVE
VALLEJO CA
94592-1107
US

IV. Provider business mailing address

404 STARBRIDGE CT
PLEASANT HILL CA
94523-4723
US

V. Phone/Fax

Practice location:
  • Phone: 707-562-8200
  • Fax:
Mailing address:
  • Phone: 714-475-9128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number107729
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: