Healthcare Provider Details

I. General information

NPI: 1144605361
Provider Name (Legal Business Name): LI FENG PETER CAO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31775 STATE ROUTE 20 # A1
OAK HARBOR WA
98277
US

IV. Provider business mailing address

31775 STATE ROUTE 20 # A1
OAK HARBOR WA
98277
US

V. Phone/Fax

Practice location:
  • Phone: 360-675-7573
  • Fax: 360-679-8896
Mailing address:
  • Phone: 360-675-7573
  • Fax: 360-679-8896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberLL-393-15
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: