Provider Demographics
NPI:1235801333
Name:HOA BANH, DMD, INC
Entity Type:Organization
Organization Name:HOA BANH, DMD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HOA
Authorized Official - Middle Name:HUNG
Authorized Official - Last Name:BANH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:209-368-6788
Mailing Address - Street 1:420 E KETTLEMAN LN STE 6
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-5957
Mailing Address - Country:US
Mailing Address - Phone:209-368-6788
Mailing Address - Fax:888-348-9455
Practice Address - Street 1:420 E KETTLEMAN LN STE 6
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-5957
Practice Address - Country:US
Practice Address - Phone:209-368-6788
Practice Address - Fax:888-348-9455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-28
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty