Provider Demographics
NPI:1700906302
Name:NGO, HUAN-TONY BAO (DDS)
Entity Type:Individual
Prefix:
First Name:HUAN-TONY
Middle Name:BAO
Last Name:NGO
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 1:6663 EL CAJON BLVD
Mailing Address - Street 2:SUITE # C-D
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-2848
Mailing Address - Country:US
Mailing Address - Phone:619-337-8005
Mailing Address - Fax:619-337-8006
Practice Address - Street 1:6663 EL CAJON BLVD
Practice Address - Street 2:SUITE # C-D
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-2848
Practice Address - Country:US
Practice Address - Phone:619-337-8005
Practice Address - Fax:619-337-8006
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA491611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice