Healthcare Provider Details

I. General information

NPI: 1316086218
Provider Name (Legal Business Name): JANET S TANZI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 WATERMAN ST
PROVIDENCE RI
02906
US

IV. Provider business mailing address

130 WATERMAN ST
PROVIDENCE RI
02906
US

V. Phone/Fax

Practice location:
  • Phone: 401-521-3746
  • Fax: 401-521-0037
Mailing address:
  • Phone: 401-521-3746
  • Fax: 401-521-0037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2173
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: