# MIKHAI C. TA, DDS, PS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Cascade Dental Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003117946
- **Authorized official:** DR. MIKHAI CONG TA DDS (OWNER)
- **Authorized official phone:** (909) 936-1803

## Contact information

- **Practice address:** 1211 S GOLD ST, CENTRALIA, WA 98531-3715
- **Practice address phone:** (360) 736-5040
- **Practice address fax:** (360) 736-1979
- **Mailing address:** PO BOX 676, CENTRALIA, WA 98531-0676
- **Mailing address phone:** (360) 736-5040
- **Mailing address fax:** (360) 736-1979

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 11/09/2010
- **Last updated:** 06/24/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2000984 | — | WA |