Provider Demographics
NPI:1427106038
Name:BANH, HOA (DMD)
Entity type:Individual
Prefix:
First Name:HOA
Middle Name:
Last Name:BANH
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 1:9227 CAPE MAY CT
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-7607
Mailing Address - Country:US
Mailing Address - Phone:916-897-0797
Mailing Address - Fax:
Practice Address - Street 1:420 E KETTLEMAN LN
Practice Address - Street 2:STE 6
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-5957
Practice Address - Country:US
Practice Address - Phone:209-368-6788
Practice Address - Fax:888-348-9455
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47042122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist