MEDICARE: DR. NICHOLAS AUSTEN TAI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	22DI02836900	NJ
2	390200000X	Student in an Organized Health Care Education/Training Program
3	1223P0221X	Pediatric Dentistry	38769	TX

General Provider Information

NPI Number	:	1437774015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS AUSTEN TAI DDS

Provider Business Mailing Address
First Line	:	7451 N BEACH ST STE 140
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-5160
Country	:	US
Telephone Number	:	817-847-7001
Fax Number	:

Provider Business Practice Location Address
First Line	:	7451 N BEACH ST STE 140
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-5160
Country	:	US
Telephone Number	:	817-847-7001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2020
Last Update Date	:	07/25/2022

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