Provider Demographics
NPI:1205358173
Name:CAO, DENNIS NGUYEN (DMD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:NGUYEN
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 1:120 HEMLOCK DR
Mailing Address - Street 2:
Mailing Address - City:DIBERVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39540-3604
Mailing Address - Country:US
Mailing Address - Phone:228-392-6438
Mailing Address - Fax:
Practice Address - Street 1:460 KELLER PKWY
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-2370
Practice Address - Country:US
Practice Address - Phone:817-242-6374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3920-17122300000X
AL6435-C1122300000X
TX370991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist