Healthcare Provider Details

I. General information

NPI: 1184116170
Provider Name (Legal Business Name): ELIZABETH HOANG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 06/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14054 US-54
NEVADA MO
64772
US

IV. Provider business mailing address

13904 PORTOFINO STRADA
OKLAHOMA CITY OK
73170-5176
US

V. Phone/Fax

Practice location:
  • Phone: 405-230-7360
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2018018439
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: