Provider Demographics
NPI:1043403777
Name:HOANG, MARK BAO (DMD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:BAO
Last Name:HOANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8001 ROOSEVELT BLVD
Mailing Address - Street 2:SUITE # 503
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-3038
Mailing Address - Country:US
Mailing Address - Phone:215-268-9655
Mailing Address - Fax:215-646-6166
Practice Address - Street 1:8001 ROOSEVELT BLVD
Practice Address - Street 2:SUITE # 503
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-3038
Practice Address - Country:US
Practice Address - Phone:215-268-9655
Practice Address - Fax:215-646-6166
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS 037251122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist