Healthcare Provider Details

I. General information

NPI: 1275207144
Provider Name (Legal Business Name): DANIEL HUANG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2021
Last Update Date: 10/02/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 I ST
CAMP LEJEUNE NC
28547
US

IV. Provider business mailing address

522 BLACK PEARL CIR
JACKSONVILLE NC
28546-0157
US

V. Phone/Fax

Practice location:
  • Phone: 910-451-1013
  • Fax:
Mailing address:
  • Phone: 931-436-1868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN122454
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13436
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: