=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487842332
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOANG ORTHODONTICS, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2007
-----------------------------------------------------
Last Update Date | 10/04/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11811 FM 1960 RD W SUITE 150
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77065-3827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-955-0380
-----------------------------------------------------
Fax | 281-955-0392
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11811 FM 1960 RD W SUITE 150
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77065-3827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-955-0380
-----------------------------------------------------
Fax | 281-955-0392
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. LAM QUY HOANG
-----------------------------------------------------
Credential | DDS, MS
-----------------------------------------------------
Telephone | 281-955-0380
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 305S00000X
-----------------------------------------------------
Taxonomy Name | Point of Service
-----------------------------------------------------
License Number | 20631
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------