Provider Demographics
NPI:1396180246
Name:GEORGE J. TAO, DDS, INC.
Entity Type:Organization
Organization Name:GEORGE J. TAO, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/GENERAL DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:JI-JUN
Authorized Official - Last Name:TAO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-987-4113
Mailing Address - Street 1:6626 CARNELIAN ST
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-4515
Mailing Address - Country:US
Mailing Address - Phone:909-987-4113
Mailing Address - Fax:909-987-3673
Practice Address - Street 1:6626 CARNELIAN ST
Practice Address - Street 2:
Practice Address - City:ALTA LOMA
Practice Address - State:CA
Practice Address - Zip Code:91701-4515
Practice Address - Country:US
Practice Address - Phone:909-987-4113
Practice Address - Fax:909-987-3673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty