Provider Demographics
NPI:1073176699
Name:MICHAEL HO, DMD, A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:MICHAEL HO, DMD, A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:847-641-0366
Mailing Address - Street 1:13350 PACIFIC PL UNIT 2217
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-8227
Mailing Address - Country:US
Mailing Address - Phone:847-641-0366
Mailing Address - Fax:
Practice Address - Street 1:16918 DOVE CANYON RD STE 201
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-3457
Practice Address - Country:US
Practice Address - Phone:847-641-0366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental