Provider Demographics
NPI:1215244256
Name:NGO, LISA ANH DAO (DDS)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANH DAO
Last Name:NGO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 CORPORATE WAY
Mailing Address - Street 2:STE 1
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-6118
Mailing Address - Country:US
Mailing Address - Phone:916-424-1703
Mailing Address - Fax:916-424-1724
Practice Address - Street 1:1108 CORPORATE WAY
Practice Address - Street 2:STE 1
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-6118
Practice Address - Country:US
Practice Address - Phone:916-424-1703
Practice Address - Fax:916-424-1724
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA576161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice