Provider Demographics
NPI:1851537179
Name:RAYMOND M. TASH, DDS, APC
Entity Type:Organization
Organization Name:RAYMOND M. TASH, DDS, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:M
Authorized Official - Last Name:TASH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-923-9700
Mailing Address - Street 1:9950 LONG BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-1503
Mailing Address - Country:US
Mailing Address - Phone:323-923-9700
Mailing Address - Fax:323-923-9712
Practice Address - Street 1:9950 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-1503
Practice Address - Country:US
Practice Address - Phone:323-923-9700
Practice Address - Fax:323-923-9712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-17
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43564122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty