Provider Demographics
NPI:1376756411
Name:HOANG, BAO N (DDS)
Entity Type:Individual
Prefix:DR
First Name:BAO
Middle Name:N
Last Name:HOANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 W. MOCKINGBIRD LANE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247
Mailing Address - Country:US
Mailing Address - Phone:214-630-7080
Mailing Address - Fax:214-630-7085
Practice Address - Street 1:1420 W. MOCKINGBIRD LANE
Practice Address - Street 2:SUITE 500
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247
Practice Address - Country:US
Practice Address - Phone:214-630-7080
Practice Address - Fax:214-630-7085
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX20193OtherCHIP NUMBER
TX164820601Medicaid