Provider Demographics
NPI:1437760279
Name:TAPIA, EMILIO (DDS)
Entity Type:Individual
Prefix:
First Name:EMILIO
Middle Name:
Last Name:TAPIA
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 1:855 W SOUTHERN AVE APT 1128
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-5069
Mailing Address - Country:US
Mailing Address - Phone:619-361-4087
Mailing Address - Fax:
Practice Address - Street 1:3401 S MCCLINTOCK DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-5820
Practice Address - Country:US
Practice Address - Phone:480-339-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105014122300000X
AZD010832122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist