Provider Demographics
NPI:1467677732
Name:DAN, LOC THANH (DDS)
Entity Type:Individual
Prefix:DR
First Name:LOC
Middle Name:THANH
Last Name:DAN
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 1:14170 BROOKHURST ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-4658
Mailing Address - Country:US
Mailing Address - Phone:714-638-8706
Mailing Address - Fax:714-638-5349
Practice Address - Street 1:14170 BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4658
Practice Address - Country:US
Practice Address - Phone:714-638-8706
Practice Address - Fax:714-638-5349
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB40803122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist