Provider Demographics
NPI:1609961267
Name:MA, CHUN-TAO T (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHUN-TAO
Middle Name:T
Last Name:MA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3985 STEVE REYNOLDS BLVD
Mailing Address - Street 2:SUITE K101
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-3035
Mailing Address - Country:US
Mailing Address - Phone:770-806-1255
Mailing Address - Fax:770-806-1254
Practice Address - Street 1:3985 STEVE REYNOLDS BLVD
Practice Address - Street 2:SUITE K101
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-3035
Practice Address - Country:US
Practice Address - Phone:770-806-1255
Practice Address - Fax:770-806-1254
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA012973122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist