Provider Demographics
NPI:1972652212
Name:MONGLAN HO, D.D.S., INC.
Entity Type:Organization
Organization Name:MONGLAN HO, D.D.S., INC.
Other - Org Name:DENTALAND II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MONGLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-899-1212
Mailing Address - Street 1:6735 WESTMINSTER BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-3772
Mailing Address - Country:US
Mailing Address - Phone:714-899-1212
Mailing Address - Fax:714-899-2009
Practice Address - Street 1:6735 WESTMINSTER BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-3772
Practice Address - Country:US
Practice Address - Phone:714-899-1212
Practice Address - Fax:714-899-2009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA426611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG92093-02Medicaid
CAB42661-02OtherDELTA HEALTHY FAMILY