Provider Demographics
NPI:1114798246
Name:DAO-NGUYEN DMD PA
Entity Type:Organization
Organization Name:DAO-NGUYEN DMD PA
Other - Org Name:ZENITH DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:863-216-3369
Mailing Address - Street 1:39863 HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-7802
Mailing Address - Country:US
Mailing Address - Phone:863-216-3369
Mailing Address - Fax:863-216-3368
Practice Address - Street 1:39863 HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-7802
Practice Address - Country:US
Practice Address - Phone:863-216-3369
Practice Address - Fax:863-216-3368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-09
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1043986359Medicaid
MO1134744477Medicaid