Provider Demographics
NPI:1497279889
Name:HO, DUNG T (DMD)
Entity Type:Individual
Prefix:DR
First Name:DUNG
Middle Name:T
Last Name:HO
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 1:8455 FERN AVE APT 1902
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5790
Mailing Address - Country:US
Mailing Address - Phone:407-968-5374
Mailing Address - Fax:
Practice Address - Street 1:7251 YOUREE DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5104
Practice Address - Country:US
Practice Address - Phone:318-737-1726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA68111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice