Provider Demographics
NPI:1275068025
Name:E M TASH DDS PC
Entity Type:Organization
Organization Name:E M TASH DDS PC
Other - Org Name:LA PUENTE DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:TASH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-333-8166
Mailing Address - Street 1:864 N HACIENDA BLVD
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-2847
Mailing Address - Country:US
Mailing Address - Phone:626-333-8166
Mailing Address - Fax:626-333-9879
Practice Address - Street 1:864 N HACIENDA BLVD
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-2847
Practice Address - Country:US
Practice Address - Phone:626-333-8166
Practice Address - Fax:626-333-9879
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:-
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-28
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47422261QD0000X, 305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherEIN NUMBER