Provider Demographics
NPI:1962693283
Name:TAI, MARIO EA WA (DMD, DMSC)
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:EA WA
Last Name:TAI
Suffix:
Gender:M
Credentials:DMD, DMSC
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Other - First Name:
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Mailing Address - Street 1:2803 LADRILLO AISLE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-8819
Mailing Address - Country:US
Mailing Address - Phone:646-708-3709
Mailing Address - Fax:949-861-9889
Practice Address - Street 1:4050 BARRANCA PKWY
Practice Address - Street 2:SUITE 220
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-7706
Practice Address - Country:US
Practice Address - Phone:646-708-3709
Practice Address - Fax:949-861-9889
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA537351223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics