Provider Demographics
NPI:1699298414
Name:ORLY TAITZ, INC
Entity type:Organization
Organization Name:ORLY TAITZ, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORP.
Authorized Official - Prefix:
Authorized Official - First Name:ORLY
Authorized Official - Middle Name:
Authorized Official - Last Name:TAITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-683-5411
Mailing Address - Street 1:29839 SANTA MARGARITA
Mailing Address - Street 2:STE 100
Mailing Address - City:RANCO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688
Mailing Address - Country:US
Mailing Address - Phone:949-766-7687
Mailing Address - Fax:949-766-7603
Practice Address - Street 1:29839 SANTA MARGARITA PKWY STE 100
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-3616
Practice Address - Country:US
Practice Address - Phone:949-766-7687
Practice Address - Fax:949-766-7603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37934122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty