Individual
DR. MARIO EA WA TAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D., D.M.SC.
Contact information
Practice address
4050 BARRANCA PKWY, SUITE 220, IRVINE, CA 92604-7706
(646) 708-3709
(949) 861-9889
Mailing address
2803 LADRILLO AISLE, IRVINE, CA 92606-8819
(646) 708-3709
(949) 861-9889
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
53735
CA
Other
Enumeration date
08/05/2007
Last updated
10/12/2012
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