Provider Demographics
NPI:1417389586
Name:HSIUNG, EDWIN (DDS)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:HSIUNG
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 1:12603 HENDERSON RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-6549
Mailing Address - Country:US
Mailing Address - Phone:813-962-2731
Mailing Address - Fax:813-961-4399
Practice Address - Street 1:12603 HENDERSON RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-6549
Practice Address - Country:US
Practice Address - Phone:813-962-2731
Practice Address - Fax:813-961-4399
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL93741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice