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General NPI Number Information
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NPI Number | 1124323357
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Entity Type | Organization
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Legal Business Name | HAOSON DENTAL GROUP
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Dates
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Enumeration Date | 01/19/2011
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Last Update Date | 06/03/2015
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Provider Practice Location Address
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Address Line | 6 GARRETT RD
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City | UPPER DARBY
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State | PA
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Zip | 19082-2303
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Country | US
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Telephone | 610-352-4525
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Fax | 610-352-4525
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Provider Business Mailing Address
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Address Line | 6 GARRETT RD
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City | UPPER DARBY
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State | PA
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Zip | 19082-2303
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | WEIXIONG STEPHEN HAO
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Credential | D.M.D.
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Telephone | 610-352-4525
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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 | DS036164
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License Number State | PA
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