Provider Demographics
NPI:1881971869
Name:HOANG, LISA T (DDS)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:T
Last Name:HOANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9709 ANGELINA CT
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95212-3139
Mailing Address - Country:US
Mailing Address - Phone:209-518-0544
Mailing Address - Fax:
Practice Address - Street 1:9709 ANGELINA CT
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95212-3139
Practice Address - Country:US
Practice Address - Phone:209-518-0544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60801122300000X
TX27483122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist