Ethan Thien Ta, DMD

NPI #1376432302 in Camp Pendleton, California

Provider Information

NPI Number: 1376432302
Entity Type: Individual
Name: Ethan Thien Ta, DMD
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dentist
Credential: DMD
Enumeration Date: Jul 2, 2025
Last Updated: Jul 2, 2025

Practice Location

Address: 200 MERCY CIRCLE
City: Camp Pendleton
State: California
ZIP Code: 92055
Phone: (760) 725-5870

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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