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General NPI Number Information
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NPI Number | 1265617765
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Entity Type | Organization
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Legal Business Name | MICHAEL TASIC DDS A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 01/02/2008
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Last Update Date | 01/02/2008
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Provider Practice Location Address
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Address Line | 8781 VAN NUYS BLVD
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City | PANORAMA CITY
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State | CA
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Zip | 91402-2401
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Country | US
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Telephone | 818-672-8289
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Fax |
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Provider Business Mailing Address
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Address Line | 19000 HAWTHORNE BLVD
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City | TORRANCE
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State | CA
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Zip | 90503-1517
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Country | US
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Telephone | 818-624-4326
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL TASIC
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Credential | DDS
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Telephone | 818-624-4326
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 27932
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License Number State | CA
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