Provider Demographics
NPI:1407823008
Name:HO, MY THI THIEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MY
Middle Name:THI THIEN
Last Name:HO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 HINKLE ST SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-4930
Mailing Address - Country:US
Mailing Address - Phone:505-843-7493
Mailing Address - Fax:505-843-7581
Practice Address - Street 1:2116 HINKLE ST SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-4930
Practice Address - Country:US
Practice Address - Phone:505-843-7493
Practice Address - Fax:505-843-7581
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD22431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM01833758Medicaid