Provider Demographics
NPI:1568685352
Name:HWANG, MICHAEL K (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:K
Last Name:HWANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-2245
Mailing Address - Country:US
Mailing Address - Phone:860-528-3427
Mailing Address - Fax:860-528-4477
Practice Address - Street 1:1175 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-2245
Practice Address - Country:US
Practice Address - Phone:860-528-3427
Practice Address - Fax:860-528-4477
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009577122300000X
CT95771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice