Healthcare Provider Details

I. General information

NPI: 1538444773
Provider Name (Legal Business Name): DUC TUAN HOANG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 E MAIN ST # 131
MIDDLETOWN NY
10940-5118
US

IV. Provider business mailing address

3450 WAYNE AVE APT 8D
BRONX NY
10467-2517
US

V. Phone/Fax

Practice location:
  • Phone: 845-342-5866
  • Fax:
Mailing address:
  • Phone: 817-781-8653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number058969
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: