Provider Demographics
NPI:1225126790
Name:HOA DUONG, DMD, P.C.
Entity Type:Organization
Organization Name:HOA DUONG, DMD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-441-1005
Mailing Address - Street 1:466 MERRIMACK ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-3907
Mailing Address - Country:US
Mailing Address - Phone:978-441-1005
Mailing Address - Fax:978-970-1185
Practice Address - Street 1:466 MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-3907
Practice Address - Country:US
Practice Address - Phone:978-441-1005
Practice Address - Fax:978-970-1185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16537261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9784446Medicaid
MA0268526Medicaid