Individual provider · Type 1 NPI

Ethan Thien Ta, DMD

Dentist · Fpo, AP

NPI number 1376432302 Active

Practice location

Psc 475 Box 1
Fpo, AP 96350-1200

Call (315) 243-7144 Map

Mailing address

15290 Dundee Ave
Apple Valley, MN 55124-5889

Specialties and licenses

TaxonomyCodeLicense
Dentist Primary 122300000X111703 (CA)

Dentist: A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requiremen…

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About NPI 1376432302

Ethan Thien Ta, DMD's National Provider Identifier is 1376432302, issued on Jul 2, 2025. The primary taxonomy on file is Dentist (122300000X), and the practice location is in Fpo, AP. The record was last updated on Aug 24, 2026.