Healthcare Provider Details

I. General information

NPI: 1790458842
Provider Name (Legal Business Name): EDDIE A TAPIA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 N I ST
MADERA CA
93637-3075
US

IV. Provider business mailing address

615 N I ST
MADERA CA
93637-3075
US

V. Phone/Fax

Practice location:
  • Phone: 559-673-8044
  • Fax:
Mailing address:
  • Phone: 559-673-8044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number37635
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: