Provider Demographics
NPI:1295011310
Name:HUANG, GRACE (DMD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:
Last Name:HUANG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:HUANG
Other - Last Name:LINDBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:189 N. BASCOM AVE.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128
Mailing Address - Country:US
Mailing Address - Phone:408-292-2848
Mailing Address - Fax:
Practice Address - Street 1:189 N. BASCOM AVE.
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128
Practice Address - Country:US
Practice Address - Phone:408-292-2848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51593122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist