Healthcare Provider Details

I. General information

NPI: 1093322836
Provider Name (Legal Business Name): LAN HOANG DAO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2020
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6711 MISSION BELL DR
HOUSTON TX
77083-2524
US

IV. Provider business mailing address

6711 MISSION BELL DR
HOUSTON TX
77083-2524
US

V. Phone/Fax

Practice location:
  • Phone: 832-475-1897
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number36722
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: