Provider Demographics
NPI:1487839619
Name:HA, BO G (DDS)
Entity Type:Individual
Prefix:DR
First Name:BO
Middle Name:G
Last Name:HA
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 1:234 PRAIRIE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-1002
Mailing Address - Country:US
Mailing Address - Phone:631-338-0118
Mailing Address - Fax:
Practice Address - Street 1:900 MERCHANTS CONCOURSE
Practice Address - Street 2:SUITE LL8
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-5142
Practice Address - Country:US
Practice Address - Phone:516-683-9100
Practice Address - Fax:516-683-1232
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0516061223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics