Healthcare Provider Details

I. General information

NPI: 1740422617
Provider Name (Legal Business Name): DUY KHIEM HOANG XUAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2009
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 S SHERIDAN BLVD STE C
LAKEWOOD CO
80226-2447
US

IV. Provider business mailing address

95 S SHERIDAN BLVD STE C
LAKEWOOD CO
80226-2447
US

V. Phone/Fax

Practice location:
  • Phone: 720-524-3959
  • Fax: 720-596-4482
Mailing address:
  • Phone: 720-524-3959
  • Fax: 720-596-4482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8352
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: