| Theodore A Tanabe Dds A Professional Corporation | |
|
13203 Hadley Street Suite 101 Whittier CA 90601 | |
| (562) 698-0387 | |
| (562) 696-7677 |
| Full Name | Theodore A Tanabe Dds A Professional Corporation |
|---|---|
| Speciality | Dentist |
| Location | 13203 Hadley Street, Whittier, California |
| Authorized Official Name and Position | Theodore A Tanabe (PRESIDENT) |
| Authorized Official Contact | 5626980387 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Theodore A Tanabe Dds A Professional Corporation 13203 Hadley Street Suite 101 Whittier CA 90601 Ph: (562) 698-0387 | Theodore A Tanabe Dds A Professional Corporation 13203 Hadley Street Suite 101 Whittier CA 90601 Ph: (562) 698-0387 |
| NPI Number | 1730489014 |
|---|---|
| Provider Enumeration Date | 11/02/2010 |
| Last Update Date | 12/26/2017 |
| Medicare PECOS PAC ID | 1759575509 |
|---|---|
| Medicare Enrollment ID | O20101105000139 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730489014 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 39716 (California) | Primary |
| 261QS0112X | Clinic/center - Oral And Maxillofacial Surgery | 39716 (California) | Secondary |
| Provider Name | Theodore Alvin Tanabe |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1982625372 PECOS PAC ID: 2668666413 Enrollment ID: I20101105000280 |
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