Healthcare Provider Details

I. General information

NPI: 1053868331
Provider Name (Legal Business Name): CHIA-YIN TAI D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2016
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 N MURPHY RD STE 100
MURPHY TX
75094-4336
US

IV. Provider business mailing address

1216 AMY DR
ALLEN TX
75013-3356
US

V. Phone/Fax

Practice location:
  • Phone: 972-836-0108
  • Fax:
Mailing address:
  • Phone: 202-812-9198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number32245
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: