Provider Demographics
NPI:1255522603
Name:NGO, THAO THI (DDS)
Entity type:Individual
Prefix:DR
First Name:THAO
Middle Name:THI
Last Name:NGO
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 1:15944 LOS SERRANOS COUNTRY CLUB DR STE 120
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-3254
Mailing Address - Country:US
Mailing Address - Phone:909-606-0853
Mailing Address - Fax:909-606-0854
Practice Address - Street 1:15944 LOS SERRANOS COUNTRY CLUB DR STE 120
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-3254
Practice Address - Country:US
Practice Address - Phone:909-606-0853
Practice Address - Fax:909-606-0854
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA570741223G0001X
AZD71411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice