Healthcare Provider Details

I. General information

NPI: 1285320507
Provider Name (Legal Business Name): CINDY HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9375 THE LANDING DR STE G130
DOUGLASVILLE GA
30135-7174
US

IV. Provider business mailing address

9375 THE LANDING DR STE G130
DOUGLASVILLE GA
30135-7174
US

V. Phone/Fax

Practice location:
  • Phone: 770-448-8882
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN016088
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN016088
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: