Provider Demographics
NPI:1740666841
Name:HOANG, BAO (DMD)
Entity type:Individual
Prefix:
First Name:BAO
Middle Name:
Last Name:HOANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 N. PIEDRAS
Mailing Address - Street 2:USA DENTAC
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79920-5001
Mailing Address - Country:US
Mailing Address - Phone:915-742-3303
Mailing Address - Fax:915-742-7462
Practice Address - Street 1:5005 N. PIEDRAS
Practice Address - Street 2:USA DENTAC
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79920-5001
Practice Address - Country:US
Practice Address - Phone:915-742-3303
Practice Address - Fax:915-742-7462
Is Sole Proprietor?:No
Enumeration Date:2015-07-31
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31197122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist