MEDICARE: HOANG DMD, PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1336607183
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOANG DMD, PLLC

Provider Business Mailing Address
First Line	:	4245 SAUBRANCH HILL ST
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27616-5999
Country	:	US
Telephone Number	:	336-541-0208
Fax Number	:

Provider Business Practice Location Address
First Line	:	6101 GRACE PARK DR
Second Line	:
City	:	MORRISVILLE
State	:	NC
Zip	:	27560-6003
Country	:	US
Telephone Number	:	336-541-0208
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BAO HOANG
Credential	:	DMD
Telephone Number	:	336-541-0208

Provider Enumeration Date	:	03/11/2019
Last Update Date	:	06/29/2019

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