Provider Demographics
NPI:1245073972
Name:HO, HUNG XUAN (DMD)
Entity type:Individual
Prefix:DR
First Name:HUNG
Middle Name:XUAN
Last Name:HO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:HELEN
Other - Middle Name:
Other - Last Name:HO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:5106 OAK ST
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-6027
Mailing Address - Country:US
Mailing Address - Phone:478-268-4959
Mailing Address - Fax:
Practice Address - Street 1:5106 OAK ST
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-6027
Practice Address - Country:US
Practice Address - Phone:478-268-4959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1234311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice