Healthcare Provider Details

I. General information

NPI: 1700550274
Provider Name (Legal Business Name): PETER HOANG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2021
Last Update Date: 08/06/2021
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MARLTON PIKE E
CHERRY HILL NJ
08034-2403
US

IV. Provider business mailing address

4622 CAMDEN AVE
PENNSAUKEN NJ
08110-2036
US

V. Phone/Fax

Practice location:
  • Phone: 856-571-4255
  • Fax:
Mailing address:
  • Phone: 856-571-4255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI02857900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: