Healthcare Provider Details

I. General information

NPI: 1467361352
Provider Name (Legal Business Name): ADAM THAHER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 W IMPERIAL HWY STE B
LA HABRA CA
90631-0604
US

IV. Provider business mailing address

1701 W IMPERIAL HWY STE B
LA HABRA CA
90631-0604
US

V. Phone/Fax

Practice location:
  • Phone: 562-690-5729
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113766
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: