Healthcare Provider Details

I. General information

NPI: 1114798246
Provider Name (Legal Business Name): DAO-NGUYEN DMD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2024
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 TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ANNA DAO
Title or Position: PROVIDER
Credential: DMD
Phone: 863-216-3369