1437159969 NPI number — HWYNN DENTAL CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437159969 NPI number — HWYNN DENTAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HWYNN DENTAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WINNING SMILES DENTAL OFFICE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437159969
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5726 E ROCKING HORSE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORANGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92869-4320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-532-0714
Provider Business Mailing Address Fax Number:
714-532-0714

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14550 MAGNOLIA ST
Provider Second Line Business Practice Location Address:
STE 103
Provider Business Practice Location Address City Name:
WESTMINSTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92683-5565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-901-0190
Provider Business Practice Location Address Fax Number:
714-901-0198
Provider Enumeration Date:
07/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HWYNN
Authorized Official First Name:
TANI
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
714-901-0190

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  44187 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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