Healthcare Provider Details

I. General information

NPI: 1205358173
Provider Name (Legal Business Name): DENNIS NGUYEN CAO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 KELLER PKWY
KELLER TX
76248-2370
US

IV. Provider business mailing address

120 HEMLOCK DR
DIBERVILLE MS
39540-3604
US

V. Phone/Fax

Practice location:
  • Phone: 817-242-6374
  • Fax:
Mailing address:
  • Phone: 228-392-6438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number3920-17
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number6435-C1
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number37099
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: