Healthcare Provider Details

I. General information

NPI: 1932560877
Provider Name (Legal Business Name): MARIA TAN RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2016
Last Update Date: 03/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 PLEASANT LAKE AVENUE
HARWICH MA
02645
US

IV. Provider business mailing address

351 PLEASANT LAKE AVENUE
HARWICH MA
02645
US

V. Phone/Fax

Practice location:
  • Phone: 508-778-5400
  • Fax: 508-778-5401
Mailing address:
  • Phone: 508-778-5400
  • Fax: 508-778-5401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number13099
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: