Provider Demographics
NPI:1881040475
Name:DAO, BAO TRAN (DMD)
Entity Type:Individual
Prefix:
First Name:BAO TRAN
Middle Name:
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 1:15511 N FLORIDA AVE STE 501
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-1215
Mailing Address - Country:US
Mailing Address - Phone:813-223-5677
Mailing Address - Fax:813-223-5688
Practice Address - Street 1:15511 N FLORIDA AVE STE 501
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-1215
Practice Address - Country:US
Practice Address - Phone:813-223-5677
Practice Address - Fax:813-223-5688
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN22427122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist