Provider Demographics
NPI:1699977231
Name:GREGG SATORU TAIRA, DDS, PA
Entity type:Organization
Organization Name:GREGG SATORU TAIRA, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:SATORU
Authorized Official - Last Name:TAIRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-963-9690
Mailing Address - Street 1:2 PROFESSIONAL DR
Mailing Address - Street 2:SUITE 245
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3408
Mailing Address - Country:US
Mailing Address - Phone:301-963-9690
Mailing Address - Fax:301-963-1631
Practice Address - Street 1:2 PROFESSIONAL DR
Practice Address - Street 2:SUITE 245
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3408
Practice Address - Country:US
Practice Address - Phone:301-963-9690
Practice Address - Fax:301-963-1631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD9304122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty