Healthcare Provider Details

I. General information

NPI: 1053162198
Provider Name (Legal Business Name): ALEXANDER NGHIA HIEP HOANG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2064 NC HIGHWAY 125
ROANOKE RAPIDS NC
27870-9436
US

IV. Provider business mailing address

P.O. BOX 640
ROANOKE RAPIDS NC
27870-0640
US

V. Phone/Fax

Practice location:
  • Phone: 252-536-5880
  • Fax: 252-536-2708
Mailing address:
  • Phone: 252-536-5844
  • Fax: 252-519-0154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number14273
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14273
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: