Provider Demographics
NPI:1760806269
Name:MADHURI S TAKALE DDS INC
Entity Type:Organization
Organization Name:MADHURI S TAKALE DDS INC
Other - Org Name:TAKALE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MADHURI
Authorized Official - Middle Name:S
Authorized Official - Last Name:TAKALE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-681-6018
Mailing Address - Street 1:21 SONATA ST
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-7021
Mailing Address - Country:US
Mailing Address - Phone:949-681-6018
Mailing Address - Fax:
Practice Address - Street 1:25381 ALICIA PKWY STE R
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-4983
Practice Address - Country:US
Practice Address - Phone:949-586-2828
Practice Address - Fax:949-586-2727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA582661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty