Provider Demographics
NPI:1427658541
Name:ANTHONY NGO, DMD PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ANTHONY NGO, DMD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:NGO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:714-855-6652
Mailing Address - Street 1:6612 SILVERSPUR LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1503
Mailing Address - Country:US
Mailing Address - Phone:714-855-6652
Mailing Address - Fax:
Practice Address - Street 1:18361 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1310
Practice Address - Country:US
Practice Address - Phone:714-855-6652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental