Provider Demographics
NPI:1891175717
Name:HOANG, MIKE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MIKE
Middle Name:
Last Name:HOANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 NW 125TH AVE # 3-219
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-6329
Mailing Address - Country:US
Mailing Address - Phone:954-662-7400
Mailing Address - Fax:
Practice Address - Street 1:2095 9TH ST N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-4806
Practice Address - Country:US
Practice Address - Phone:239-430-1515
Practice Address - Fax:239-430-1518
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-05
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21231122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist