Healthcare Provider Details

I. General information

NPI: 1104113257
Provider Name (Legal Business Name): A.H. DENTAL, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2011
Last Update Date: 08/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6619 FOREST HILL DR STE 55
FOREST HILL TX
76140-1260
US

IV. Provider business mailing address

2914 PEGASUS CT
GRAND PRAIRIE TX
75052-8042
US

V. Phone/Fax

Practice location:
  • Phone: 972-342-6705
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY HOANG
Title or Position: PRESIDENT
Credential:
Phone: 972-342-6705