Provider Demographics
NPI:1508105255
Name:DARRON TANIOKA DDS INC
Entity Type:Organization
Organization Name:DARRON TANIOKA DDS INC
Other - Org Name:CREEKSIDE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-699-3250
Mailing Address - Street 1:41785 NICOLE LN STE A3
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-3874
Mailing Address - Country:US
Mailing Address - Phone:951-699-3250
Mailing Address - Fax:951-699-3830
Practice Address - Street 1:41785 NICOLE LN STE A3
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-3874
Practice Address - Country:US
Practice Address - Phone:951-699-3250
Practice Address - Fax:951-699-3830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-31
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6781520001Medicare NSC
CA6781520001Medicare UPIN