Provider Demographics
NPI:1538245113
Name:HA, DANG VINH (DMD)
Entity type:Individual
Prefix:
First Name:DANG
Middle Name:VINH
Last Name:HA
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 1:8416 SHELDON RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-1606
Mailing Address - Country:US
Mailing Address - Phone:813-454-9091
Mailing Address - Fax:813-443-4879
Practice Address - Street 1:2091 COLLIER PKWY
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-5202
Practice Address - Country:US
Practice Address - Phone:813-948-6290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN172711223G0001X
FLDN179531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice