Provider Demographics
NPI:1336607183
Name:HOANG DMD, PLLC
Entity Type:Organization
Organization Name:HOANG DMD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BAO
Authorized Official - Middle Name:
Authorized Official - Last Name:HOANG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:336-541-0208
Mailing Address - Street 1:4245 SAUBRANCH HILL ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-5999
Mailing Address - Country:US
Mailing Address - Phone:336-541-0208
Mailing Address - Fax:
Practice Address - Street 1:6101 GRACE PARK DR
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-6003
Practice Address - Country:US
Practice Address - Phone:336-541-0208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-11
Last Update Date:2019-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental