Provider Demographics
NPI:1760593933
Name:TAI, ALICE H (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:H
Last Name:TAI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 BOLLINGER CANYON WAY STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-4935
Mailing Address - Country:US
Mailing Address - Phone:925-735-1881
Mailing Address - Fax:925-735-1440
Practice Address - Street 1:525 BOLLINGER CANYON WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94582-4935
Practice Address - Country:US
Practice Address - Phone:925-735-1881
Practice Address - Fax:925-735-1440
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA384641223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics