Healthcare Provider Details

I. General information

NPI: 1891175717
Provider Name (Legal Business Name): MIKE HOANG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2015
Last Update Date: 06/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2095 9TH ST N
NAPLES FL
34102-4806
US

IV. Provider business mailing address

2900 NW 125TH AVE # 3-219
SUNRISE FL
33323-6329
US

V. Phone/Fax

Practice location:
  • Phone: 239-430-1515
  • Fax: 239-430-1518
Mailing address:
  • Phone: 954-662-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN21231
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: