Provider Demographics
NPI:1346560554
Name:SHERRY P TSAI DDS INC
Entity Type:Organization
Organization Name:SHERRY P TSAI DDS INC
Other - Org Name:MILLBRAE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:DRAHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:650-583-5880
Mailing Address - Street 1:88 CAPUCHINO DR
Mailing Address - Street 2:
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94030-1258
Mailing Address - Country:US
Mailing Address - Phone:650-583-5880
Mailing Address - Fax:650-475-0596
Practice Address - Street 1:88 CAPUCHINO DR
Practice Address - Street 2:
Practice Address - City:MILLBRAE
Practice Address - State:CA
Practice Address - Zip Code:94030-1258
Practice Address - Country:US
Practice Address - Phone:650-583-5880
Practice Address - Fax:650-475-0596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6410660001Medicare NSC