Provider Demographics
NPI:1174802243
Name:HOANG, ALICE (DMD)
Entity type:Individual
Prefix:DR
First Name:ALICE
Middle Name:
Last Name:HOANG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:ALICE
Other - Middle Name:QUYNH
Other - Last Name:HOANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:215 MAUJER ST
Mailing Address - Street 2:APT 2L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-1307
Mailing Address - Country:US
Mailing Address - Phone:843-819-1947
Mailing Address - Fax:
Practice Address - Street 1:356 W 18TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-4401
Practice Address - Country:US
Practice Address - Phone:212-271-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055634122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist