Provider Demographics
NPI:1669057295
Name:MINH-KHANG ERIC NGO DENTAL CORPORATION
Entity type:Organization
Organization Name:MINH-KHANG ERIC NGO DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MINH-KHANG
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:NGO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-995-5588
Mailing Address - Street 1:980 PACIFIC ST STE A
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-5653
Mailing Address - Country:US
Mailing Address - Phone:530-622-4188
Mailing Address - Fax:
Practice Address - Street 1:980 PACIFIC ST STE A
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5653
Practice Address - Country:US
Practice Address - Phone:530-622-4188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-15
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty