MEDICARE: EDDIE TAI ENDODONTICS GROUP LLC

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	1223E0200X	Endodontics	S7-59	NV

General Provider Information

NPI Number	:	1740433630
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDDIE TAI ENDODONTICS GROUP LLC

Provider Business Mailing Address
First Line	:	526 S TONOPAH DR
Second Line	:	200
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4043
Country	:	US
Telephone Number	:	702-683-6266
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 E LAKE MEAD BLVD
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-7137
Country	:	US
Telephone Number	:	702-641-5888
Fax Number	:

Authorized Official
Title or Position	:	ENDODONTIST
Name	:	DR. EDDIE TAILUNG TAI
Credential	:	D.M.D
Telephone Number	:	702-683-6266

Provider Enumeration Date	:	10/23/2008
Last Update Date	:	10/23/2008

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