Provider Demographics
NPI:1912099110
Name:MAO, DAVID (DDS, PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:MAO
Suffix:
Gender:M
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4974 175TH PL
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-1624
Mailing Address - Country:US
Mailing Address - Phone:718-537-5000
Mailing Address - Fax:
Practice Address - Street 1:4260 MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-4741
Practice Address - Country:US
Practice Address - Phone:718-321-3755
Practice Address - Fax:718-762-6718
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0417061223P0300X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223P0300XDental ProvidersDentistPeriodontics
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDE3801OtherEMPIRE BC/BS
NY0455131OtherAETNA PPO MEDICAL
NY2038800OtherAETNA HMO
NY1394731OtherUNITED CONCORDIA
NY28680OtherDENTAL BENEFIT PROVIDERS
NYSD608OtherOXFORD
NY0455131OtherAETNA PPO MEDICAL