Provider Demographics
NPI:1942410204
Name:DOAN, PHUONG D (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHUONG
Middle Name:D
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 1:340 MADISON AVENUE, SUITE 4C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10173-1909
Mailing Address - Country:US
Mailing Address - Phone:917-805-3628
Mailing Address - Fax:
Practice Address - Street 1:340 MADISON AVENUE, SUITE 4C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10173-1909
Practice Address - Country:US
Practice Address - Phone:917-805-3628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0496701223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics