Healthcare Provider Details

I. General information

NPI: 1275628364
Provider Name (Legal Business Name): BICH LIEN THI CAO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 MATLOCK RD SUITE 103
ARLINGTON TX
76015-2920
US

IV. Provider business mailing address

3125 MATLOCK RD SUITE 103
ARLINGTON TX
76015-2920
US

V. Phone/Fax

Practice location:
  • Phone: 817-795-5690
  • Fax: 817-465-9899
Mailing address:
  • Phone: 817-795-5690
  • Fax: 817-465-9899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number17981
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: