Healthcare Provider Details

I. General information

NPI: 1629381330
Provider Name (Legal Business Name): ANDY TRONG CAO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2010
Last Update Date: 07/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2819 LARKDALE DR
PEARLAND TX
77584-7084
US

IV. Provider business mailing address

2819 LARKDALE DR
PEARLAND TX
77584-7084
US

V. Phone/Fax

Practice location:
  • Phone: 832-274-4399
  • Fax:
Mailing address:
  • Phone: 832-274-4399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0025538
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: