Provider Demographics
NPI:1366839821
Name:BRANDON HOANG DENTAL CORPORATION
Entity Type:Organization
Organization Name:BRANDON HOANG DENTAL CORPORATION
Other - Org Name:ISMILES KIDS DENTISTRY AND ORTHODONTICS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:TUAN
Authorized Official - Last Name:HOANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-273-9992
Mailing Address - Street 1:2097 COMPTON AVE
Mailing Address - Street 2:SUITE 104B
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-7282
Mailing Address - Country:US
Mailing Address - Phone:951-273-9992
Mailing Address - Fax:951-273-9991
Practice Address - Street 1:2097 COMPTON AVE
Practice Address - Street 2:SUITE 104B
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-7282
Practice Address - Country:US
Practice Address - Phone:951-273-9992
Practice Address - Fax:951-273-9991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA559201223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty