Healthcare Provider Details

I. General information

NPI: 1497022768
Provider Name (Legal Business Name): TONY HSU D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 11/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11300 ROCKVILLE PIKE SUITE 1008
NORTH BETHESDA MD
20852-3003
US

IV. Provider business mailing address

11300 ROCKVILLE PIKE SUITE 1008
NORTH BETHESDA MD
20852-3003
US

V. Phone/Fax

Practice location:
  • Phone: 301-881-6882
  • Fax:
Mailing address:
  • Phone: 301-881-6882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number1223G0001X
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: