Provider Demographics
NPI:1740352129
Name:CAO, HON VAN (DDS)
Entity type:Individual
Prefix:DR
First Name:HON
Middle Name:VAN
Last Name:CAO
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 1:3667 ARLINGTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3939
Mailing Address - Country:US
Mailing Address - Phone:951-684-6600
Mailing Address - Fax:951-684-3631
Practice Address - Street 1:3667 ARLINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3939
Practice Address - Country:US
Practice Address - Phone:951-684-6600
Practice Address - Fax:951-684-3631
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA38655122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9069701OtherDENTICAL MEDICAL