Healthcare Provider Details

I. General information

NPI: 1104955160
Provider Name (Legal Business Name): RICHARD J TANANIS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12000 OLD VINE BLVD UNIT 112
LEWES DE
19958-1717
US

IV. Provider business mailing address

12000 OLD VINE BLVD UNIT 112
LEWES DE
19958-1717
US

V. Phone/Fax

Practice location:
  • Phone: 302-645-4726
  • Fax: 302-485-5863
Mailing address:
  • Phone: 302-645-4726
  • Fax: 302-485-5863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberG1-0001134
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: