Provider Demographics
NPI:1376052530
Name:HUANG DDS, DENTAL CORP
Entity Type:Organization
Organization Name:HUANG DDS, DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:HUANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-828-5567
Mailing Address - Street 1:8074 PARK VILLA CIR
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-4064
Mailing Address - Country:US
Mailing Address - Phone:1408-828-5567
Mailing Address - Fax:
Practice Address - Street 1:1641 EL CAMINO REAL
Practice Address - Street 2:100
Practice Address - City:MILLBRAE
Practice Address - State:CA
Practice Address - Zip Code:94030-1269
Practice Address - Country:US
Practice Address - Phone:650-989-8711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-20
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25907261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1710019161OtherTYPE 1 NPI NUMBER
CA25907OtherCA DENTAL LICENSE
CA25907OtherDENTAL PERMIT