Provider Demographics
NPI:1417310954
Name:TAT, ANTHONY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:TAT
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 1:4778 MOORPARK AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-2041
Mailing Address - Country:US
Mailing Address - Phone:408-807-4853
Mailing Address - Fax:
Practice Address - Street 1:10440 S DE ANZA BLVD
Practice Address - Street 2:SUITE D-4
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3018
Practice Address - Country:US
Practice Address - Phone:408-807-4853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1000741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice