Healthcare Provider Details

I. General information

NPI: 1548792740
Provider Name (Legal Business Name): PHUONG CAO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 04/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11399 VETERANS MEMORIAL DR
HOUSTON TX
77067-3800
US

IV. Provider business mailing address

11399 VETERANS MEMORIAL DR
HOUSTON TX
77067-3800
US

V. Phone/Fax

Practice location:
  • Phone: 281-444-4488
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number33350
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: