Healthcare Provider Details

I. General information

NPI: 1043986359
Provider Name (Legal Business Name): ANNA A DAO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39863 HIGHWAY 27
DAVENPORT FL
33837-7802
US

IV. Provider business mailing address

39863 HIGHWAY 27
DAVENPORT FL
33837-7802
US

V. Phone/Fax

Practice location:
  • Phone: 863-216-3369
  • Fax: 863-216-3368
Mailing address:
  • Phone: 863-216-3369
  • Fax: 863-216-3368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number4547
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number26313
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: