Provider Demographics
NPI:1689871246
Name:DOAN, CAMHA THI (DDS)
Entity Type:Individual
Prefix:MISS
First Name:CAMHA
Middle Name:THI
Last Name:DOAN
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 1:1350 15TH ST
Mailing Address - Street 2:APT 14D
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-2032
Mailing Address - Country:US
Mailing Address - Phone:917-952-1910
Mailing Address - Fax:
Practice Address - Street 1:2505 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-4011
Practice Address - Country:US
Practice Address - Phone:917-405-4038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0531661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice