Provider Demographics
NPI:1144605361
Name:CAO, LI FENG PETER (DMD)
Entity Type:Individual
Prefix:MR
First Name:LI FENG
Middle Name:PETER
Last Name:CAO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31775 STATE ROUTE 20 # A1
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277
Mailing Address - Country:US
Mailing Address - Phone:360-675-7573
Mailing Address - Fax:360-679-8896
Practice Address - Street 1:31775 STATE ROUTE 20 # A1
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277
Practice Address - Country:US
Practice Address - Phone:360-675-7573
Practice Address - Fax:360-679-8896
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLL-393-151223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2080759Medicaid