Provider Demographics
NPI:1982057709
Name:CHAO, ANNIE (DMD)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:
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 1:635 S ELLIS ST APT 2079
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-4968
Mailing Address - Country:US
Mailing Address - Phone:408-656-9193
Mailing Address - Fax:
Practice Address - Street 1:1835 E GUADALUPE RD STE C-107
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3277
Practice Address - Country:US
Practice Address - Phone:480-345-4017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-16
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100451122300000X
AZD011046122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist