Provider Demographics
NPI:1255483152
Name:DUC M. DOAN, D.D.S., INC.
Entity Type:Organization
Organization Name:DUC M. DOAN, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DUC
Authorized Official - Middle Name:MINH
Authorized Official - Last Name:DOAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-968-4733
Mailing Address - Street 1:15260 FAIRGROVE AVE
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-1067
Mailing Address - Country:US
Mailing Address - Phone:626-968-4733
Mailing Address - Fax:626-917-1783
Practice Address - Street 1:15260 FAIRGROVE AVE
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-1067
Practice Address - Country:US
Practice Address - Phone:626-968-4733
Practice Address - Fax:626-917-1783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47613122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty