Healthcare Provider Details

I. General information

NPI: 1710279930
Provider Name (Legal Business Name): THERESA HOANG DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2011
Last Update Date: 10/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 SOUTH ST
WARE MA
01082-1617
US

IV. Provider business mailing address

90 SOUTH ST
WARE MA
01082-1617
US

V. Phone/Fax

Practice location:
  • Phone: 413-967-3385
  • Fax:
Mailing address:
  • Phone: 413-967-3385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1856469
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: