Healthcare Provider Details

I. General information

NPI: 1609320969
Provider Name (Legal Business Name): CDC ORTHODONTICS RICHARDSON PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2016
Last Update Date: 08/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 E RENNER RD 400
RICHARDSON TX
75082-2806
US

IV. Provider business mailing address

4140 E RENNER RD 400
RICHARDSON TX
75082-2806
US

V. Phone/Fax

Practice location:
  • Phone: 972-808-9600
  • Fax: 972-808-9601
Mailing address:
  • Phone: 972-808-9600
  • Fax: 972-808-9601

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: DANE L HOANG
Title or Position: SOLE MBR
Credential: DDS MS PA
Phone: 972-808-9600