=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073487443
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AL-SAADI TAKA DENTAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2025
-----------------------------------------------------
Last Update Date | 09/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12330 CARMEL MOUNTAIN RD STE C4
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92128-4654
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-485-0555
-----------------------------------------------------
Fax | 858-451-8396
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12330 CARMEL MOUNTAIN RD STE C4
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92128-4654
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-485-0555
-----------------------------------------------------
Fax | 858-451-8396
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST/CEO
-----------------------------------------------------
Name | DR. TAYEM TAKA
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 760-693-7823
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------