Provider Demographics
NPI:1992927263
Name:TSAI, WANDY (DDS)
Entity type:Individual
Prefix:DR
First Name:WANDY
Middle Name:
Last Name:TSAI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5268 SCOTTS VALLEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066-3551
Mailing Address - Country:US
Mailing Address - Phone:415-218-1496
Mailing Address - Fax:831-438-4572
Practice Address - Street 1:5268 SCOTTS VALLEY DRIVE
Practice Address - Street 2:
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-3551
Practice Address - Country:US
Practice Address - Phone:415-218-1496
Practice Address - Fax:831-438-4572
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA509951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice