Mikhai C. Ta, DDS, PS

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

MIKHAI C. TA, DDS, PS

Practice address

1211 S Gold St
Centralia, WA 98531-3715

Phone

(360) 736-5040

Fax

(360) 736-1979

NPI assigned

Nov 9, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mikhai Cong Ta, DDS

Title

Owner

Phone

(909) 936-1803

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Cascade Dental Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1289260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308873600000",
    "number": "1003117946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 676",
            "city": "CENTRALIA",
            "state": "WA",
            "postal_code": "985310676",
            "telephone_number": "360-736-5040",
            "fax_number": "360-736-1979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1211 S GOLD ST",
            "city": "CENTRALIA",
            "state": "WA",
            "postal_code": "985313715",
            "telephone_number": "360-736-5040",
            "fax_number": "360-736-1979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIKHAI C. TA, DDS, PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-09",
        "last_updated": "2011-06-24",
        "status": "A",
        "authorized_official_last_name": "TA",
        "authorized_official_first_name": "MIKHAI",
        "authorized_official_middle_name": "CONG",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-936-1803",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2000984",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cascade Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gary John Clinton Mersereau Sr., BSN, RN
• Danae Maree Metcalf, CMA
• Brent William Michaud
• Elise Michelle
• Danielle Brooke Middleton, PTA
• Lindsay Miller-Rogers, BAS, R-AAC
• Amanda Bradi Miller
• James M Miller, MD
• Jody Miller
• Maranda Keel Miller, BS, AAC

• Dentist in Centralia, WA
• Providers in Centralia, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.