Healthcare Provider Details

I. General information

NPI: 1336607183
Provider Name (Legal Business Name): HOANG DMD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2019
Last Update Date: 06/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 GRACE PARK DR
MORRISVILLE NC
27560-6003
US

IV. Provider business mailing address

4245 SAUBRANCH HILL ST
RALEIGH NC
27616-5999
US

V. Phone/Fax

Practice location:
  • Phone: 336-541-0208
  • Fax:
Mailing address:
  • Phone: 336-541-0208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BAO HOANG
Title or Position: OWNER
Credential: DMD
Phone: 336-541-0208