1104955160 NPI number — RICHARD J TANANIS D.D.S.

Table of content: RICHARD J TANANIS D.D.S. (NPI 1104955160)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104955160 NPI number — RICHARD J TANANIS D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TANANIS
Provider First Name:
RICHARD
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104955160
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30599 SUSSEX HWY
Provider Second Line Business Mailing Address:
UNIT #3
Provider Business Mailing Address City Name:
LAUREL
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19956-4417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-875-4271
Provider Business Mailing Address Fax Number:
302-875-9441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30599 SUSSEX HWY
Provider Second Line Business Practice Location Address:
UNIT #3
Provider Business Practice Location Address City Name:
LAUREL
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19956-4417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-875-4271
Provider Business Practice Location Address Fax Number:
302-875-9441
Provider Enumeration Date:
03/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  G1-0001134 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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