Pon T Tath, D.M.D.
Individual provider Active NPI General Practice Dentistry · Boonville, CA
NPI 1225260623 · NPPES record last updated Dec 9, 2019
Key facts
- NPI
- 1225260623
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 58706 (CA)
- Practice address
- 13500 Airport Rd
Boonville, CA 95415-9133 - Phone
- (707) 895-3477
- Fax
- (707) 895-2035
- NPI assigned
- Aug 18, 2009
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 58706 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tath Family Dental, Inc | Past |
Accepting new patients | |
| Anderson Valley Ambulance Service | Past | Accepting new patients | |
| Anderson Valley Health Center | Past |
Accepting new patients |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/BICHAA
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 58706 | CA | Yes |
Addresses
Primary practice location
13500 Airport Rd
Boonville, CA 95415-9133
Mailing address
PO Box 7783
Stockton, CA 95267-0783
Phone (209) 597-3145
Other practice location 1
220 Towne Centre Dr
Lathrop, CA 95330-9533
Phone (209) 597-3145
Other providers in Boonville, CA
- Christopher Howard
- Toni Marie Mann
- Cindy S Novella
- Stephanie Shreve
- Cary Lynn Smeltzer
- Vintage Vinetours LLC
All providers in Boonville, CA · General Practice Dentistry in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 9, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.