Healthcare Provider Details

I. General information

NPI: 1891156188
Provider Name (Legal Business Name): CDC ORTHODONTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2016
Last Update Date: 03/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 FOREST LN
DALLAS TX
75243-4113
US

IV. Provider business mailing address

8900 FOREST LN
DALLAS TX
75043
US

V. Phone/Fax

Practice location:
  • Phone: 972-234-4500
  • Fax: 972-234-4501
Mailing address:
  • Phone: 972-234-4500
  • Fax: 972-234-4501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number18843
License Number StateTX

VIII. Authorized Official

Name: DR. DANE HOANG
Title or Position: OWNER
Credential:
Phone: 972-234-4500