Provider Demographics
NPI:1093900458
Name:DO, WILLIAM QUYEN DOAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:QUYEN DOAN
Last Name:DO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:MR
Other - First Name:QUYEN
Other - Middle Name:DOAN
Other - Last Name:DO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:945 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-3950
Mailing Address - Country:US
Mailing Address - Phone:209-836-0443
Mailing Address - Fax:209-836-0490
Practice Address - Street 1:945 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3950
Practice Address - Country:US
Practice Address - Phone:209-836-0443
Practice Address - Fax:209-836-0490
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA435271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG91480-01OtherDENTI-CAL
CAB43527OtherDELTA DENTAL STATE GOVT P