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Organization
MIKHAI C. TA, DDS, PS
Active
Organization
MIKHAI C. TA, DDS, PS
Active
Other names
Cascade Dental Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MIKHAI CONG TA DDS (OWNER)
(909) 936-1803
Entity
Organization
Contact information
Practice address
1211 S GOLD ST, CENTRALIA, WA 98531-3715
(360) 736-5040
(360) 736-1979
Mailing address
PO BOX 676, CENTRALIA, WA 98531-0676
(360) 736-5040
(360) 736-1979
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
NULL
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2000984
—
WA
Enumeration date
11/09/2010
Last updated
06/24/2011
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