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General NPI Number Information
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NPI Number | 1699977231
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Entity Type | Organization
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Legal Business Name | GREGG SATORU TAIRA, DDS, PA
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Dates
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Enumeration Date | 06/05/2007
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Last Update Date | 11/13/2012
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Provider Practice Location Address
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Address Line | 2 PROFESSIONAL DR SUITE 245
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City | GAITHERSBURG
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State | MD
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Zip | 20879-3408
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Country | US
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Telephone | 301-963-9690
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Fax | 301-963-1631
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Provider Business Mailing Address
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Address Line | 2 PROFESSIONAL DR SUITE 245
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City | GAITHERSBURG
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State | MD
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Zip | 20879-3408
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Country | US
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Telephone | 301-963-9690
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Fax | 301-963-1631
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GREGG SATORU TAIRA
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Credential | D.D.S.
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Telephone | 301-963-9690
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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 | 9304
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License Number State | MD
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