Basic Information
| Provider Information | |||||||||
| NPI: | 1235230855 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CONG | ||||||||
| FirstName: | MYANH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 HIGH ST FL 4 | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450116078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134541460 | ||||||||
| FaxNumber: | 5134541484 | ||||||||
| Practice Location | |||||||||
| Address1: | 1036 S VERITY PKWY | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450445513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5314258305 | ||||||||
| FaxNumber: | 5134251810 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2006 | ||||||||
| LastUpdateDate: | 12/27/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 12/27/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 022422 | OH | Y | Dental Providers | Dentist | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 1941062 | 01 | OH | UNITED CONCORDIA | OTHER | 2737355 | 05 | OH | MEDICAID | 7100087790 | 05 | KY | MEDICAID | 200999390 | 05 | IN | MEDICAID | 9200551 | 01 | OH | DENTAQUEST | OTHER |