=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952053290
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TASKER AND ROWAN DENTAL CORPORATION OF MILPITAS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2022
-----------------------------------------------------
Last Update Date | 01/18/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6560 LONETREE BLVD STE 102
-----------------------------------------------------
City | ROCKLIN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95765-5891
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-479-3432
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 530 W 21ST ST
-----------------------------------------------------
City | MERCED
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95340-3719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-479-3432
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | JEANNINE SASO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 916-479-3432
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------