Provider Demographics
NPI:1972714525
Name:HOANG, NICOLE DIEM (DMD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:DIEM
Last Name:HOANG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 SALVIO ST STE 275
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-2459
Mailing Address - Country:US
Mailing Address - Phone:925-682-4912
Mailing Address - Fax:925-682-4826
Practice Address - Street 1:2151 SALVIO ST STE 275
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2459
Practice Address - Country:US
Practice Address - Phone:925-682-4912
Practice Address - Fax:925-682-4826
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45702122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist