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General NPI Number Information
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NPI Number | 1134614159
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Entity Type | Individual
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Provider Name | EMILY THAI DMD
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Gender | Female
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Dates
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Enumeration Date | 06/22/2018
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Last Update Date | 06/22/2018
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Provider Practice Location Address
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Address Line | 2199 MAIN ST
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City | OAKLEY
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State | CA
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Zip | 94561-3303
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Country | US
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Telephone | 925-575-9504
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Fax |
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Provider Business Mailing Address
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Address Line | 3055 SUMMERHILL CT
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City | SAN JOSE
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State | CA
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Zip | 95148-3146
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Country | US
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Telephone | 408-781-6192
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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 | 102523
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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 | 102523
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License Number State | CA
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