Healthcare Provider Details

I. General information

NPI: 1518557776
Provider Name (Legal Business Name): VI DAO ENDODONTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2021
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5720 STONERIDGE MALL RD STE 280
PLEASANTON CA
94588-2830
US

IV. Provider business mailing address

1034 MURRIETA BLVD
LIVERMORE CA
94550-4111
US

V. Phone/Fax

Practice location:
  • Phone: 714-592-4488
  • Fax:
Mailing address:
  • Phone: 925-443-3636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VI DAO
Title or Position: OWNER
Credential: DDS
Phone: 714-592-4488