Provider Demographics
NPI:1053312322
Name:HA, QUANG
Entity Type:Individual
Prefix:MR
First Name:QUANG
Middle Name:
Last Name:HA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 KNIGHTSBOROUGH WAY
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-4551
Mailing Address - Country:US
Mailing Address - Phone:919-272-8075
Mailing Address - Fax:919-941-5569
Practice Address - Street 1:5400 S MIAMI BLVD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-8465
Practice Address - Country:US
Practice Address - Phone:919-941-5549
Practice Address - Fax:919-941-5569
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC69091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice