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General NPI Number Information
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NPI Number | 1134579824
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Entity Type | Individual
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Provider Name | RENEE TAI D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 06/14/2016
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Last Update Date | 03/25/2024
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Provider Practice Location Address
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Address Line | 1417 E FRONT ST
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City | PORT ANGELES
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State | WA
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Zip | 98362-4618
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Country | US
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Telephone | 360-457-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 1520 WEATHERVANE DR
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City | FIRCREST
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State | WA
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Zip | 98466-5715
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE60487996
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License Number State | WA
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