Provider Demographics
NPI:1942350558
Name:TONTHAT, CUONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:CUONG
Middle Name:
Last Name:TONTHAT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:TINO
Other - Middle Name:CUONG
Other - Last Name:TONTHAT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:56 N 13TH ST
Mailing Address - Street 2:STE. 102
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-3438
Mailing Address - Country:US
Mailing Address - Phone:408-295-2530
Mailing Address - Fax:
Practice Address - Street 1:56 N 13TH ST
Practice Address - Street 2:STE. 102
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-3438
Practice Address - Country:US
Practice Address - Phone:408-295-2530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA452061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice