Provider Demographics
NPI:1962133173
Name:TAYANI DENTAL GROUP INC
Entity type:Organization
Organization Name:TAYANI DENTAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-458-4402
Mailing Address - Street 1:24001 CALLE DE LA MAGDALENA UNIT 3533
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92654-1261
Mailing Address - Country:US
Mailing Address - Phone:714-458-4402
Mailing Address - Fax:
Practice Address - Street 1:1460 N HARBOR BLVD STE 120
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-4158
Practice Address - Country:US
Practice Address - Phone:714-458-4402
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty