Basic Information
| Provider Information | |||||||||
| NPI: | 1518170059 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HONG | ||||||||
| FirstName: | GARRICK | ||||||||
| MiddleName: | SCOTT | ||||||||
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| Credential: | D.D.S | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 22210 | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946232210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105354000 | ||||||||
| FaxNumber: | 5105354225 | ||||||||
| Practice Location | |||||||||
| Address1: | 3050 E. 16TH ST. | ||||||||
| Address2: | FRUITVALE DENTAL | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946012319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105354700 | ||||||||
| FaxNumber: | 5105354283 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2007 | ||||||||
| LastUpdateDate: | 08/23/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DDS53999 | CA | N | Dental Providers | Dentist | 1223G0001X | 53999 | CA | Y | Dental Providers | Dentist | General Practice |
No ID Information.