Healthcare Provider Details

I. General information

NPI: 1902284516
Provider Name (Legal Business Name): TANJIT TAGGAR D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 LEIGH FARM RD APARTMENT 109
DURHAM NC
27707-8110
US

IV. Provider business mailing address

2024 CHESTERFIELD AVE APT 109
CHARLOTTE NC
28205-0013
US

V. Phone/Fax

Practice location:
  • Phone: 908-938-5998
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number13605
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401414360
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number150954
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: