MEDICARE: MR. QUANG HA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	6909	NC

General Provider Information

NPI Number	:	1053312322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. QUANG HA

Provider Business Mailing Address
First Line	:	607 KNIGHTSBOROUGH WAY
Second Line	:
City	:	APEX
State	:	NC
Zip	:	27502-4551
Country	:	US
Telephone Number	:	919-272-8075
Fax Number	:	919-941-5569

Provider Business Practice Location Address
First Line	:	5400 S MIAMI BLVD
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27703-8465
Country	:	US
Telephone Number	:	919-941-5549
Fax Number	:	919-941-5569

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/08/2007

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Practice Fax:

Directions to “ MR. QUANG HA ” Practice Location

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