Healthcare Provider Details

I. General information

NPI: 1578818357
Provider Name (Legal Business Name): HECHANG HUANG D.D.S,M.S.D,M.S,PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 07/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SULLIVAN HL RM 170
STONY BROOK NY
11794-8705
US

IV. Provider business mailing address

ROCKLAND HL RM 120A
STONY BROOK NY
11794-8700
US

V. Phone/Fax

Practice location:
  • Phone: 631-632-8971
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number000033
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: