Provider Demographics
NPI:1841618105
Name:WANDY W TSAI DDS INC.
Entity Type:Organization
Organization Name:WANDY W TSAI DDS INC.
Other - Org Name:SCOTTS VALLEY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WANDY
Authorized Official - Middle Name:W
Authorized Official - Last Name:TSAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:831-438-8503
Mailing Address - Street 1:5268 SCOTTS VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066-3551
Mailing Address - Country:US
Mailing Address - Phone:831-438-8503
Mailing Address - Fax:
Practice Address - Street 1:5268 SCOTTS VALLEY DR
Practice Address - Street 2:
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-3551
Practice Address - Country:US
Practice Address - Phone:831-438-8503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA509951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty