Provider Demographics
NPI:1255593349
Name:DAO, CHAU MINH (DDS)
Entity type:Individual
Prefix:DR
First Name:CHAU
Middle Name:MINH
Last Name:DAO
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 1:2516 W PETERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-4109
Mailing Address - Country:US
Mailing Address - Phone:773-743-4050
Mailing Address - Fax:773-743-3711
Practice Address - Street 1:834 W MONTROSE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-5813
Practice Address - Country:US
Practice Address - Phone:773-989-9160
Practice Address - Fax:773-989-9165
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019025873122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL203524551OtherEMPLOYER TAX IDENTIFICATION NUMBER
IL203524368OtherEMPLOYER TAX IDENTIFICATION NUMBER