Healthcare Provider Details

I. General information

NPI: 1952830580
Provider Name (Legal Business Name): MICHAEL D. HOANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 06/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 PALM BAY RD NE
WEST MELBOURNE FL
32904-8602
US

IV. Provider business mailing address

750 PEMBROKE AVE NE
PALM BAY FL
32907-1616
US

V. Phone/Fax

Practice location:
  • Phone: 321-482-5220
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22679
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: