Provider Demographics
NPI:1124223755
Name:DAO, PHUONG THI (DMD)
Entity Type:Individual
Prefix:MRS
First Name:PHUONG
Middle Name:THI
Last Name:DAO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 BROADWAY
Mailing Address - Street 2:1
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-3126
Mailing Address - Country:US
Mailing Address - Phone:617-389-8317
Mailing Address - Fax:
Practice Address - Street 1:910 BROADWAY
Practice Address - Street 2:1
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-3126
Practice Address - Country:US
Practice Address - Phone:617-389-8317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA175731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice