Provider Demographics
NPI:1225131493
Name:WILLIAM K TADANO DDS PC
Entity Type:Organization
Organization Name:WILLIAM K TADANO DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:TADANO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-864-0004
Mailing Address - Street 1:7550 N 19TH AVE
Mailing Address - Street 2:101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021
Mailing Address - Country:US
Mailing Address - Phone:602-864-0004
Mailing Address - Fax:602-864-0070
Practice Address - Street 1:7550 N 19TH AVE
Practice Address - Street 2:101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021
Practice Address - Country:US
Practice Address - Phone:602-864-0004
Practice Address - Fax:602-864-0070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20201223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty