Provider Demographics
NPI:1750483673
Name:HOANG, JACQUELYN
Entity Type:Individual
Prefix:MS
First Name:JACQUELYN
Middle Name:
Last Name:HOANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14912 FALCONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-1349
Mailing Address - Country:US
Mailing Address - Phone:240-593-6329
Mailing Address - Fax:703-877-2100
Practice Address - Street 1:14912 FALCONWOOD DR
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-1349
Practice Address - Country:US
Practice Address - Phone:240-593-6329
Practice Address - Fax:703-877-2100
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12018122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist