Healthcare Provider Details

I. General information

NPI: 1740694538
Provider Name (Legal Business Name): CUONG DAO DDS, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10450 S PROGRESS WAY UNIT 100
PARKER CO
80134-4036
US

IV. Provider business mailing address

6243 N ELMIRA ST
DENVER CO
80238
US

V. Phone/Fax

Practice location:
  • Phone: 720-780-0865
  • Fax:
Mailing address:
  • Phone: 989-327-0323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number021.002939
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDEN.00204938
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: