Healthcare Provider Details

I. General information

NPI: 1295975019
Provider Name (Legal Business Name): KIEU-TRINH THI DAO D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2009
Last Update Date: 03/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4431 W WALNUT ST STE A
GARLAND TX
75042-4108
US

IV. Provider business mailing address

12801 MIDWAY RD STE 401
DALLAS TX
75244-6829
US

V. Phone/Fax

Practice location:
  • Phone: 972-485-1200
  • Fax: 972-485-1211
Mailing address:
  • Phone: 214-232-5062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number16697
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: