Provider Demographics
NPI:1285642355
Name:QUANG, PHUONG N (DDS)
Entity type:Individual
Prefix:DR
First Name:PHUONG
Middle Name:N
Last Name:QUANG
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 1:2844 SUMMIT STREET, SUITE 209
Mailing Address - Street 2:BAY ENDODONTICS
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609
Mailing Address - Country:US
Mailing Address - Phone:510-451-3636
Mailing Address - Fax:510-451-3607
Practice Address - Street 1:2844 SUMMIT STREET, SUITE 209
Practice Address - Street 2:BAY ENDODONTICS
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609
Practice Address - Country:US
Practice Address - Phone:510-451-3636
Practice Address - Fax:510-451-3607
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA543011223G0001X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice