Organization
THEODORE A TANABE DDS A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THEODORE A TANABE DDS (PRESIDENT)
(562) 698-0387
Entity
Organization
Contact information
Practice address
13203 HADLEY STREET, SUITE 101, WHITTIER, CA 90601
(562) 698-0387
(562) 696-7677
Mailing address
13203 HADLEY STREET, SUITE 101, WHITTIER, CA 90601
(562) 698-0387
(562) 896-7677
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
39716
CA
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
39716
CA
Other
Enumeration date
11/02/2010
Last updated
12/26/2017
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