Provider Demographics
NPI:1285815316
Name:MICHAEL K HWANG, DMD, LLC
Entity Type:Organization
Organization Name:MICHAEL K HWANG, DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:HWANG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:203-984-1794
Mailing Address - Street 1:1175 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-2245
Mailing Address - Country:US
Mailing Address - Phone:860-528-3427
Mailing Address - Fax:860-528-4477
Practice Address - Street 1:1175 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-2245
Practice Address - Country:US
Practice Address - Phone:860-528-3427
Practice Address - Fax:860-528-4477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0095771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty