Healthcare Provider Details

I. General information

NPI: 1366293482
Provider Name (Legal Business Name): JOANNE TAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2024
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1824 PEARL RD
BRUNSWICK OH
44212-3252
US

IV. Provider business mailing address

1824 PEARL RD
BRUNSWICK OH
44212-3252
US

V. Phone/Fax

Practice location:
  • Phone: 330-220-6363
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number30.028462
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: