Healthcare Provider Details

I. General information

NPI: 1477082717
Provider Name (Legal Business Name): MINHQUAN DAO DMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2017
Last Update Date: 07/22/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4470 W JEFFERSON BLVD STE 500
DALLAS TX
75211-4616
US

IV. Provider business mailing address

7122 PRESIDENTS DR
CORPUS CHRISTI TX
78414-2177
US

V. Phone/Fax

Practice location:
  • Phone: 214-333-3100
  • Fax:
Mailing address:
  • Phone: 609-992-1455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number32909
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number32909
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: