Provider Demographics
NPI:1578728630
Name:HONG, CAROLINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:
Last Name:HONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:
Other - Last Name:HONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1300 W 9TH ST APT 449
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-1033
Mailing Address - Country:US
Mailing Address - Phone:616-836-0627
Mailing Address - Fax:
Practice Address - Street 1:1455 HARRISON AVE NW
Practice Address - Street 2:SUITE 200
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-2621
Practice Address - Country:US
Practice Address - Phone:330-994-0205
Practice Address - Fax:330-994-0207
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9166122300000X
OH30-023814122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH47396Medicaid