Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | S7-59 | NV |
NPI | 1023131018 |
---|---|
Provider Name | Dr. Eddie Tailung Tai |
First Address | Las Vegas, NV 89101-3418 |
Second Address | Las Vegas, NV 89101-3418 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 14/02/2012 |