Provider Demographics
NPI:1841531514
Name:THAI DENTAL CORPORATION
Entity type:Organization
Organization Name:THAI DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MINDI
Authorized Official - Middle Name:
Authorized Official - Last Name:THAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-274-9988
Mailing Address - Street 1:5645 SILVER CREEK VALLEY RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95138-2474
Mailing Address - Country:US
Mailing Address - Phone:408-274-9988
Mailing Address - Fax:408-841-9714
Practice Address - Street 1:5645 SILVER CREEK VALLEY RD
Practice Address - Street 2:SUITE 220
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95138-2474
Practice Address - Country:US
Practice Address - Phone:408-274-9988
Practice Address - Fax:408-841-9714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA490101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty