Healthcare Provider Details

I. General information

NPI: 1790516227
Provider Name (Legal Business Name): HA THANH HOANG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2623 HOUSLEY RD
ANNAPOLIS MD
21401-7648
US

IV. Provider business mailing address

5103 BALTIMORE LN
LANHAM MD
20706-2020
US

V. Phone/Fax

Practice location:
  • Phone: 410-793-4922
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number18294
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: