Provider Demographics
NPI:1629124078
Name:CAO, LIEU THI (DDS)
Entity Type:Individual
Prefix:
First Name:LIEU
Middle Name:THI
Last Name:CAO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1253 PLEASANT GROVE BLVD STE 190
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-6971
Mailing Address - Country:US
Mailing Address - Phone:916-780-2262
Mailing Address - Fax:916-780-1808
Practice Address - Street 1:1253 PLEASANT GROVE BLVD STE 190
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-6971
Practice Address - Country:US
Practice Address - Phone:916-780-2262
Practice Address - Fax:916-780-1808
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA504471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice