Provider Demographics
NPI:1134291057
Name:THAI DENTAL CORPORATION
Entity Type:Organization
Organization Name:THAI DENTAL CORPORATION
Other - Org Name:DBA UNITED DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:THAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-790-8088
Mailing Address - Street 1:34400 FREMONT BLVD STE #C
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-3322
Mailing Address - Country:US
Mailing Address - Phone:510-790-8088
Mailing Address - Fax:510-790-8098
Practice Address - Street 1:34400 FREMONT BLVD STE C
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94555-3322
Practice Address - Country:US
Practice Address - Phone:510-790-8088
Practice Address - Fax:510-790-8098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA446321223G0001X
CA445791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty