Provider Demographics
NPI:1518131051
Name:HUANG DDS PLLC
Entity Type:Organization
Organization Name:HUANG DDS PLLC
Other - Org Name:LIGHTHOUSE FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:HUANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-769-6267
Mailing Address - Street 1:11700 MUKILTEO SPEEDWAY
Mailing Address - Street 2:#502
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-5432
Mailing Address - Country:US
Mailing Address - Phone:425-290-5573
Mailing Address - Fax:425-290-3643
Practice Address - Street 1:401 S MILWAUKEE AVE
Practice Address - Street 2:#200
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-5070
Practice Address - Country:US
Practice Address - Phone:847-215-6600
Practice Address - Fax:847-403-3275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE602273081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty