Healthcare Provider Details

I. General information

NPI: 1720909880
Provider Name (Legal Business Name): NHA PHONG CAO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2081 1ST ST
ALAMOGORDO NM
88310-5233
US

IV. Provider business mailing address

1776 1ST ST APT 1C
ALAMOGORDO NM
88310-5274
US

V. Phone/Fax

Practice location:
  • Phone: 575-437-7900
  • Fax:
Mailing address:
  • Phone: 408-807-4247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDB-2026-0311
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: