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General NPI Number Information
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NPI Number | 1104010396
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Entity Type | Organization
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Legal Business Name | JEANETTE HUONG THAI, DDS, INC.
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Dates
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Enumeration Date | 08/30/2007
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Last Update Date | 02/11/2020
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Provider Practice Location Address
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Address Line | 24432 MUIRLANDS BLVD STE 201
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City | LAKE FOREST
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State | CA
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Zip | 92630-3939
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Country | US
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Telephone | 949-837-8482
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Fax | 949-837-9858
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Provider Business Mailing Address
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Address Line | 24432 MUIRLANDS BLVD STE 201
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City | LAKE FOREST
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State | CA
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Zip | 92630-3939
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Country | US
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Telephone | 949-837-8482
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Fax | 949-837-9858
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEANETTE HUONG THAI
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Credential | DDS
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Telephone | 949-837-8482
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 36015
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License Number State | CA
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