Healthcare Provider Details

I. General information

NPI: 1225157597
Provider Name (Legal Business Name): DANNY TAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 E BORONDA RD SUITE B
SALINAS CA
93907-2026
US

IV. Provider business mailing address

324 BUSH ST 608 E BORONDA RD STE B
SALINAS CA
93907-2026
US

V. Phone/Fax

Practice location:
  • Phone: 831-449-9776
  • Fax: 831-449-9451
Mailing address:
  • Phone: 831-449-9776
  • Fax: 831-449-9451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number40989
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: