Provider Demographics
NPI:1881386324
Name:GAO, MONIQUE ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:ANN
Last Name:GAO
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 1:40628 LOS ALAMOS RD APT 2102
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-2707
Mailing Address - Country:US
Mailing Address - Phone:818-857-0575
Mailing Address - Fax:
Practice Address - Street 1:40760 CALIFORNIA OAKS RD
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5791
Practice Address - Country:US
Practice Address - Phone:951-677-3078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
CA1111561223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program