Provider Demographics
NPI:1700107810
Name:VAN, HANG (DMD)
Entity Type:Individual
Prefix:
First Name:HANG
Middle Name:
Last Name:VAN
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 1:4184 MAYFAIR LN
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-7506
Mailing Address - Country:US
Mailing Address - Phone:352-214-4744
Mailing Address - Fax:
Practice Address - Street 1:4184 MAYFAIR LN
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-7506
Practice Address - Country:US
Practice Address - Phone:352-214-4744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-13
Last Update Date:2010-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19018122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist