Provider Demographics
NPI:1104010396
Name:JEANETTE HUONG THAI, DDS, INC.
Entity Type:Organization
Organization Name:JEANETTE HUONG THAI, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:HUONG
Authorized Official - Last Name:THAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-837-8482
Mailing Address - Street 1:24432 MUIRLANDS BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-3939
Mailing Address - Country:US
Mailing Address - Phone:949-837-8482
Mailing Address - Fax:949-837-9858
Practice Address - Street 1:24432 MUIRLANDS BLVD STE 201
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-3939
Practice Address - Country:US
Practice Address - Phone:949-837-8482
Practice Address - Fax:949-837-9858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA360151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty