Provider Demographics
NPI:1265793079
Name:HOANG, HUNG ANH (DDS)
Entity type:Individual
Prefix:DR
First Name:HUNG
Middle Name:ANH
Last Name:HOANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70053-5934
Mailing Address - Country:US
Mailing Address - Phone:504-366-3052
Mailing Address - Fax:504-366-9201
Practice Address - Street 1:406 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-5934
Practice Address - Country:US
Practice Address - Phone:504-366-3052
Practice Address - Fax:504-366-9201
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA62701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice