Provider Demographics
NPI:1700253572
Name:AUNG MYO THANT DDS INC
Entity Type:Organization
Organization Name:AUNG MYO THANT DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AUNG
Authorized Official - Middle Name:MYO
Authorized Official - Last Name:THANT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-427-8363
Mailing Address - Street 1:4207 KEEVER AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3016
Mailing Address - Country:US
Mailing Address - Phone:562-427-8363
Mailing Address - Fax:
Practice Address - Street 1:4207 KEEVER AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3016
Practice Address - Country:US
Practice Address - Phone:562-427-8363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52477122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty