Healthcare Provider Details

I. General information

NPI: 1285995787
Provider Name (Legal Business Name): DAVID THANH HOANG D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2012
Last Update Date: 04/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 N MAY AVE
OKLAHOMA CITY OK
73112-5406
US

IV. Provider business mailing address

5401 N MAY AVE
OKLAHOMA CITY OK
73112-5406
US

V. Phone/Fax

Practice location:
  • Phone: 405-996-1030
  • Fax:
Mailing address:
  • Phone: 405-996-1030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6393
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: