Provider Demographics
NPI:1235440371
Name:HOANG, UYEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:UYEN
Middle Name:
Last Name:HOANG
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 1:2794 PLENNIE LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-6760
Mailing Address - Country:US
Mailing Address - Phone:770-963-5999
Mailing Address - Fax:
Practice Address - Street 1:650 GWINNETT DR STE 210
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7439
Practice Address - Country:US
Practice Address - Phone:770-963-5999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL57761223G0001X
GADN015129122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist