Healthcare Provider Details

I. General information

NPI: 1811440019
Provider Name (Legal Business Name): CHRISTINA KELLY CAO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2016
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3667 ARLINGTON AVE
RIVERSIDE CA
92506-3939
US

IV. Provider business mailing address

3667 ARLINGTON AVE
RIVERSIDE CA
92506-3939
US

V. Phone/Fax

Practice location:
  • Phone: 949-892-9782
  • Fax: 951-684-3631
Mailing address:
  • Phone: 951-684-6600
  • Fax: 951-684-3631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS100417
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS100417
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: