Healthcare Provider Details

I. General information

NPI: 1134055692
Provider Name (Legal Business Name): MAUNG OO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 FARMERS LN
SANTA ROSA CA
95405-6707
US

IV. Provider business mailing address

5043 KARRINGTON RD
ROHNERT PARK CA
94928-5046
US

V. Phone/Fax

Practice location:
  • Phone: 707-536-0225
  • Fax:
Mailing address:
  • Phone: 267-939-7652
  • Fax: 267-939-7652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS113048
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: