Healthcare Provider Details

I. General information

NPI: 1194433581
Provider Name (Legal Business Name): STACEY CAO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2022
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4902 IRVINE CENTER DR STE 101
IRVINE CA
92604-3334
US

IV. Provider business mailing address

3308 S ALTON CT
SANTA ANA CA
92704-7013
US

V. Phone/Fax

Practice location:
  • Phone: 949-552-1701
  • Fax:
Mailing address:
  • Phone: 714-742-5284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number108178
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: