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General NPI Number Information
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NPI Number | 1134291057
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Entity Type | Organization
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Legal Business Name | THAI DENTAL CORPORATION
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 06/01/2015
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Provider Practice Location Address
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Address Line | 34400 FREMONT BLVD STE C
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City | FREMONT
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State | CA
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Zip | 94555-3322
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Country | US
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Telephone | 510-790-8088
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Fax | 510-790-8098
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Provider Business Mailing Address
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Address Line | 34400 FREMONT BLVD STE #C
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City | FREMONT
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State | CA
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Zip | 94555-3322
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Country | US
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Telephone | 510-790-8088
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Fax | 510-790-8098
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. PETER THAI
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Credential | DDS
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Telephone | 510-790-8088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 44579
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 44632
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License Number State | CA
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