Healthcare Provider Details

I. General information

NPI: 1740702018
Provider Name (Legal Business Name): BAO TRAN HUYNH UNG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2017
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 CROSSROADS PLZ
FORT MILL SC
29708-8017
US

IV. Provider business mailing address

30 HOLLAND DR APT 4
CHAPEL HILL NC
27514-4723
US

V. Phone/Fax

Practice location:
  • Phone: 803-396-7833
  • Fax:
Mailing address:
  • Phone: 704-438-5332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10786
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: