Provider Demographics
NPI:1437166899
Name:DOAN, TAI (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAI
Middle Name:
Last Name:DOAN
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 1:2114 SENTER RD STE 25
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-2608
Mailing Address - Country:US
Mailing Address - Phone:408-295-7556
Mailing Address - Fax:
Practice Address - Street 1:2114 SENTER RD STE 25
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-2608
Practice Address - Country:US
Practice Address - Phone:408-295-7556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice