MEDICARE: THAI DENTAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	49010	CA

General Provider Information

NPI Number	:	1841531514
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THAI DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	5645 SILVER CREEK VALLEY RD
Second Line	:	SUITE 220
City	:	SAN JOSE
State	:	CA
Zip	:	95138-2474
Country	:	US
Telephone Number	:	408-274-9988
Fax Number	:	408-841-9714

Provider Business Practice Location Address
First Line	:	5645 SILVER CREEK VALLEY RD
Second Line	:	SUITE 220
City	:	SAN JOSE
State	:	CA
Zip	:	95138-2474
Country	:	US
Telephone Number	:	408-274-9988
Fax Number	:	408-841-9714

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MINDI THAI
Credential	:	DDS
Telephone Number	:	408-274-9988

Provider Enumeration Date	:	03/06/2013
Last Update Date	:	03/06/2013

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Directions to “THAI DENTAL CORPORATION ” Practice Location

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