Healthcare Provider Details

I. General information

NPI: 1518131051
Provider Name (Legal Business Name): HUANG DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 07/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S MILWAUKEE AVE #200
WHEELING IL
60090-5070
US

IV. Provider business mailing address

11700 MUKILTEO SPEEDWAY #502
MUKILTEO WA
98275-5432
US

V. Phone/Fax

Practice location:
  • Phone: 847-215-6600
  • Fax: 847-403-3275
Mailing address:
  • Phone: 425-290-5573
  • Fax: 425-290-3643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE60227308
License Number StateWA

VIII. Authorized Official

Name: DR. MATTHEW HUANG
Title or Position: PRESIDENT
Credential: DDS
Phone: 847-769-6267