Provider Demographics
NPI:1467835660
Name:DOAN, DUNG MY (DMD)
Entity Type:Individual
Prefix:DR
First Name:DUNG
Middle Name:MY
Last Name:DOAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 GLEN ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-4135
Mailing Address - Country:US
Mailing Address - Phone:720-635-0139
Mailing Address - Fax:
Practice Address - Street 1:15 TUFTS ST
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129-2711
Practice Address - Country:US
Practice Address - Phone:857-238-1115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1857231122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist