Healthcare Provider Details

I. General information

NPI: 1699429126
Provider Name (Legal Business Name): SPENCER J TASKER DMD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2022
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4840 IRVINE BLVD STE 106
IRVINE CA
92620-1962
US

IV. Provider business mailing address

4840 IRVINE BLVD STE 106
IRVINE CA
92620-1962
US

V. Phone/Fax

Practice location:
  • Phone: 949-885-9300
  • Fax:
Mailing address:
  • Phone: 949-885-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JEN SASO
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 916-479-3432