Provider Demographics
NPI:1194867788
Name:TAO, GEORGE JI JUN (DDS)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:JI JUN
Last Name:TAO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9588 BASELINE RD. STE 100
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-6439
Mailing Address - Country:US
Mailing Address - Phone:909-987-4113
Mailing Address - Fax:909-987-3678
Practice Address - Street 1:6626 CARNELIAN ST
Practice Address - Street 2:
Practice Address - City:ALTA LOMA
Practice Address - State:CA
Practice Address - Zip Code:91701
Practice Address - Country:US
Practice Address - Phone:909-987-4113
Practice Address - Fax:909-987-3673
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42703122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist