Provider Demographics
NPI:1871583401
Name:UNG, HA DOAN THI (DDS)
Entity type:Individual
Prefix:
First Name:HA
Middle Name:DOAN THI
Last Name:UNG
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 1:28B S FREDERICK AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-2302
Mailing Address - Country:US
Mailing Address - Phone:301-330-6234
Mailing Address - Fax:301-330-6235
Practice Address - Street 1:28B S FREDERICK AVE
Practice Address - Street 2:STE 101
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2302
Practice Address - Country:US
Practice Address - Phone:301-330-6234
Practice Address - Fax:301-330-6235
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD132131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG177238Medicaid