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General NPI Number Information
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NPI Number | 1194867788
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Entity Type | Individual
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Provider Name | GEORGE JI JUN TAO DDS
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Gender | Male
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 09/07/2021
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Provider Practice Location Address
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Address Line | 6626 CARNELIAN ST
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City | ALTA LOMA
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State | CA
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Zip | 91701
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Country | US
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Telephone | 909-987-4113
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Fax | 909-987-3673
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Provider Business Mailing Address
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Address Line | 9588 BASELINE RD. STE 100
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91701-6439
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Country | US
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Telephone | 909-987-4113
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Fax | 909-987-3678
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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 | 42703
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License Number State | CA
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