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Individual
MIKHAI CONG TA
Active
Individual
MIKHAI CONG TA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
102306
CA
122300000X
Dentist
10476
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1852977
UNITED CONCORDIA
WA
Enumeration date
08/14/2006
Last updated
10/03/2018
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