Provider Demographics
NPI:1215134473
Name:CHAO, MAGGIE T (DMD)
Entity type:Individual
Prefix:DR
First Name:MAGGIE
Middle Name:T
Last Name:CHAO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 CEDARWOOD LANE SUITE C
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566
Mailing Address - Country:US
Mailing Address - Phone:925-425-7545
Mailing Address - Fax:844-272-2154
Practice Address - Street 1:1475 CEDARWOOD LANE SUITE C
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566
Practice Address - Country:US
Practice Address - Phone:925-425-7545
Practice Address - Fax:844-272-2154
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA478101223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA47810OtherDENTAL LICENSE NUMBER