Healthcare Provider Details

I. General information

NPI: 1912099110
Provider Name (Legal Business Name): DAVID MAO D.D.S., P.H.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4260 MAIN ST SUITE A
FLUSHING NY
11355-4741
US

IV. Provider business mailing address

4974 175TH PL
FRESH MEADOWS NY
11365-1624
US

V. Phone/Fax

Practice location:
  • Phone: 718-321-3755
  • Fax: 718-762-6718
Mailing address:
  • Phone: 718-537-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number041706
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number041706
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: