Healthcare Provider Details

I. General information

NPI: 1154516466
Provider Name (Legal Business Name): BINH BAO DAO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 PROFESSIONAL DRIVE
ROSEVILLE CA
95661-9425
US

IV. Provider business mailing address

2424 PROFESSIONAL DR
ROSEVILLE CA
95661-7773
US

V. Phone/Fax

Practice location:
  • Phone: 916-783-4888
  • Fax:
Mailing address:
  • Phone: 916-783-4888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number55884
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number55884
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: