Provider Demographics
NPI:1790925535
Name:G.R. TASHIRO DDS, INC
Entity Type:Organization
Organization Name:G.R. TASHIRO DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:TASHIRO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-644-9007
Mailing Address - Street 1:21001 COVELLO ST
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-1403
Mailing Address - Country:US
Mailing Address - Phone:562-644-9007
Mailing Address - Fax:323-443-3904
Practice Address - Street 1:21001 COVELLO ST
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-1403
Practice Address - Country:US
Practice Address - Phone:562-644-9007
Practice Address - Fax:323-443-3904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23388122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty