Healthcare Provider Details

I. General information

NPI: 1790607810
Provider Name (Legal Business Name): MICHAEL TIMOTHY HUANG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MIKE HUANG DMD

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1384 109TH AVE NE STE 200
BLAINE MN
55434-4543
US

IV. Provider business mailing address

649 OLD HIGHWAY 8 NW APT 327
NEW BRIGHTON MN
55112-2873
US

V. Phone/Fax

Practice location:
  • Phone: 763-757-6000
  • Fax:
Mailing address:
  • Phone: 651-278-6861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD15510
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: