Healthcare Provider Details

I. General information

NPI: 1689803322
Provider Name (Legal Business Name): TRANG M CAO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 08/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 ATLANTIC BLVD
ATLANTIC BEACH FL
32233-3313
US

IV. Provider business mailing address

926 GREAT POND DR STE 2002 SUITE 2002
ALTAMONTE SPRINGS FL
32714-7244
US

V. Phone/Fax

Practice location:
  • Phone: 904-249-3104
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN 18789
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: