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General NPI Number Information
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NPI Number | 1699298414
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Entity Type | Organization
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Legal Business Name | ORLY TAITZ, INC
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Dates
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Enumeration Date | 07/24/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 29839 SANTA MARGARITA PKWY STE 100
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City | RANCHO SANTA MARGARITA
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State | CA
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Zip | 92688-3616
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Country | US
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Telephone | 949-766-7687
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Fax | 949-766-7603
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Provider Business Mailing Address
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Address Line | 29839 SANTA MARGARITA STE 100
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City | RANCO SANTA MARGARITA
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State | CA
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Zip | 92688
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Country | US
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Telephone | 949-766-7687
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Fax | 949-766-7603
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Authorized Official
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Title or Position | PRESIDENT OF CORP.
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Name | ORLY TAITZ
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Credential | DDS
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Telephone | 949-683-5411
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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 | 37934
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License Number State | CA
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