Provider Demographics
NPI:1740433630
Name:EDDIE TAI ENDODONTICS GROUP LLC
Entity type:Organization
Organization Name:EDDIE TAI ENDODONTICS GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:TAILUNG
Authorized Official - Last Name:TAI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-683-6266
Mailing Address - Street 1:526 S TONOPAH DR
Mailing Address - Street 2:200
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4043
Mailing Address - Country:US
Mailing Address - Phone:702-683-6266
Mailing Address - Fax:
Practice Address - Street 1:2301 E LAKE MEAD BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-7137
Practice Address - Country:US
Practice Address - Phone:702-641-5888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS7-591223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty