Provider Demographics
NPI:1356810758
Name:JASON H. TA, DMD, INC.
Entity type:Organization
Organization Name:JASON H. TA, DMD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:H
Authorized Official - Last Name:TA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:310-542-5558
Mailing Address - Street 1:16709 HAWTHORNE BLVD.
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260
Mailing Address - Country:US
Mailing Address - Phone:310-592-5558
Mailing Address - Fax:310-542-4309
Practice Address - Street 1:16709 HAWTHORNE BLVD.
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260
Practice Address - Country:US
Practice Address - Phone:310-592-5558
Practice Address - Fax:310-542-4309
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JASON H. TA, DMD, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty