Provider Demographics
NPI:1962686709
Name:DAO, HOA T (DDS)
Entity Type:Individual
Prefix:MR
First Name:HOA
Middle Name:T
Last Name:DAO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8950 VILLA LA JOLLA DR STE B120
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1705
Mailing Address - Country:US
Mailing Address - Phone:858-455-9614
Mailing Address - Fax:858-455-9520
Practice Address - Street 1:8950 VILLA LA JOLLA DR STE B120
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1705
Practice Address - Country:US
Practice Address - Phone:858-455-9614
Practice Address - Fax:858-455-9614
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49295122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA49295OtherDENTAL LICENSE