Provider Demographics
NPI:1740339860
Name:TAITO, LEE ANTHONY (DMD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:ANTHONY
Last Name:TAITO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1439 OAKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NAPOLEON
Mailing Address - State:OH
Mailing Address - Zip Code:43545-1066
Mailing Address - Country:US
Mailing Address - Phone:920-585-8760
Mailing Address - Fax:
Practice Address - Street 1:403 E KEMPER RD
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:OH
Practice Address - Zip Code:45246-3228
Practice Address - Country:US
Practice Address - Phone:513-729-7245
Practice Address - Fax:513-808-9656
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901017085122300000X
OH30.0219611223E0200X
IA090611223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1740339860OtherENDODONTICS