Healthcare Provider Details

I. General information

NPI: 1902199011
Provider Name (Legal Business Name): KUAN CAO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

467 WINDWOOD LAKE DR
CAPE GIRARDEAU MO
63701-9587
US

IV. Provider business mailing address

467 WINDWOOD LAKE DR
CAPE GIRARDEAU MO
63701
US

V. Phone/Fax

Practice location:
  • Phone: 443-653-0354
  • Fax:
Mailing address:
  • Phone: 443-653-0354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number056452
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2016007765
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: