Provider Demographics
NPI:1679341911
Name:HA, NANCY LINH (DDS)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:LINH
Last Name:HA
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 1:11775 GILES RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:AR
Mailing Address - Zip Code:72730-9650
Mailing Address - Country:US
Mailing Address - Phone:918-360-3773
Mailing Address - Fax:
Practice Address - Street 1:4605 PHOENIX AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-6007
Practice Address - Country:US
Practice Address - Phone:479-250-4531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4713261QD0000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental