Provider Demographics
NPI:1831362342
Name:XU, TAO (DMD)
Entity type:Individual
Prefix:
First Name:TAO
Middle Name:
Last Name:XU
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 1:909 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-5503
Mailing Address - Country:US
Mailing Address - Phone:732-878-7994
Mailing Address - Fax:
Practice Address - Street 1:909 RIVER RD
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-5503
Practice Address - Country:US
Practice Address - Phone:732-878-7994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI019762001223G0001X
MADN 18918-11223G0001X
NY55199121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice