Healthcare Provider Details

I. General information

NPI: 1033741574
Provider Name (Legal Business Name): GIA HOANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 CENTER DR RM D1-19
GAINESVILLE FL
32610-3006
US

IV. Provider business mailing address

PO BOX 100415
GAINESVILLE FL
32610-3006
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-6910
  • Fax: 352-273-5717
Mailing address:
  • Phone: 352-273-6910
  • Fax: 352-273-5717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDN24668
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: