Provider Demographics
NPI:1699041798
Name:MARIO E. TAI, D.M.D., D.M.SC., INC.
Entity Type:Organization
Organization Name:MARIO E. TAI, D.M.D., D.M.SC., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:E
Authorized Official - Last Name:TAI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:818-885-8650
Mailing Address - Street 1:18250 ROSCOE BLVD
Mailing Address - Street 2:SUITE 315
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4226
Mailing Address - Country:US
Mailing Address - Phone:818-885-8650
Mailing Address - Fax:818-885-7169
Practice Address - Street 1:18250 ROSCOE BLVD
Practice Address - Street 2:SUITE 315
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4226
Practice Address - Country:US
Practice Address - Phone:818-885-8650
Practice Address - Fax:818-885-7169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA537351223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty