Tahara, Martin A
Tahara, Martin A is an individual health care provider with primary practice located at 1701 Curve Crest Blvd W Suite 108, Stillwater MN 55082-6044. He recently has only one registered license in Dental Providers / Oral and Maxillofacial Surgery, which is considered as his primary health care specialty. Tahara, Martin A can be contacted via phone (651) 439-8030.Contact Information
Primary practice address
1701 Curve Crest Blvd W Suite 108
Stillwater MN 55082-6044
Phone: (651) 439-8030
Fax: (651) 351-0821
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Oral and Maxillofacial Surgery | 1223S0112X | D11409 | Minnesota |
| Dental Providers / Oral and Maxillofacial Surgery | 1223S0112X | 5219-015 | Wisconsin |
Profile Details
| NPI number | 1053381061 |
|---|---|
| LBN Legal business name | Tahara, Martin A |
| Credentials | DMD, MD |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 23rd, 2006 |
| Last updated | Jul 9th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1053381061 | NPPES |
| Wisconsin | MEDICAID | 33761200 |
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