Provider Demographics
NPI:1902866114
Name:HUANG, ADRIAN G (DMD)
Entity Type:Individual
Prefix:DR
First Name:ADRIAN
Middle Name:G
Last Name:HUANG
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 1:1234 N 900 E
Mailing Address - Street 2:#100
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-2719
Mailing Address - Country:US
Mailing Address - Phone:801-854-9140
Mailing Address - Fax:801-854-9142
Practice Address - Street 1:1234 N 900 E
Practice Address - Street 2:#100
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-2719
Practice Address - Country:US
Practice Address - Phone:801-854-9140
Practice Address - Fax:801-854-9142
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7431369-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT7431369-9921OtherUTAH DOPL