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General NPI Number Information
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NPI Number | 1295395796
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Entity Type | Organization
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Legal Business Name | PLEASANT HILL PROSTHODONTICS
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Dates
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Enumeration Date | 06/17/2019
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Last Update Date | 06/17/2019
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Provider Practice Location Address
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Address Line | 401 GREGORY LN STE 130
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City | PLEASANT HILL
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State | CA
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Zip | 94523-2836
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Country | US
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Telephone | 925-681-1801
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Fax | 925-681-1802
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Provider Business Mailing Address
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Address Line | 3647 PERADA DR
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City | WALNUT CREEK
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State | CA
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Zip | 94598-2743
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Country | US
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Telephone | 949-690-3849
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. THUY TRAN THIEN HOANG
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Credential | DDS
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Telephone | 925-681-1801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number |
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License Number State |
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