Healthcare Provider Details

I. General information

NPI: 1740339860
Provider Name (Legal Business Name): LEE ANTHONY TAITO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 05/21/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 E KEMPER RD
SPRINGDALE OH
45246-3228
US

IV. Provider business mailing address

1439 OAKWOOD AVE
NAPOLEON OH
43545-1066
US

V. Phone/Fax

Practice location:
  • Phone: 513-729-7245
  • Fax: 513-808-9656
Mailing address:
  • Phone: 920-585-8760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2901017085
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number30.021961
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number09061
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: