Healthcare Provider Details

I. General information

NPI: 1073834248
Provider Name (Legal Business Name): JAMES R TAGONI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 01/27/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 3RD AVE SE
CEDAR RAPIDS IA
52403-2407
US

IV. Provider business mailing address

901 TOWER TERRACE RD
MARION IA
52302-8975
US

V. Phone/Fax

Practice location:
  • Phone: 319-366-8277
  • Fax: 319-366-7091
Mailing address:
  • Phone: 319-366-8277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN22298
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberA141168
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDL-10923
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: