Provider Demographics
NPI:1063461234
Name:DO, HANH MINH (DMD)
Entity Type:Individual
Prefix:DR
First Name:HANH
Middle Name:MINH
Last Name:DO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MANOR AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-2298
Mailing Address - Country:US
Mailing Address - Phone:502-348-3119
Mailing Address - Fax:502-348-8399
Practice Address - Street 1:101 MANOR AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-2298
Practice Address - Country:US
Practice Address - Phone:502-348-3119
Practice Address - Fax:502-348-8399
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY82521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60003555Medicaid
KY9179401OtherPASSPORT PROVIDER NO.