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General NPI Number Information
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NPI Number | 1124291166
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Entity Type | Organization
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Legal Business Name | ROGER G. TANS, D.D.S., P.A.
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Dates
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Enumeration Date | 04/10/2008
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Last Update Date | 04/10/2008
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Provider Practice Location Address
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Address Line | 3121 SPRINGBANK LN STE D
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City | CHARLOTTE
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State | NC
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Zip | 28226-3347
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Country | US
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Telephone | 704-341-0016
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Fax |
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Provider Business Mailing Address
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Address Line | 3121 SPRINGBANK LN STE D
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City | CHARLOTTE
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State | NC
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Zip | 28226-3347
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Country | US
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Telephone | 704-341-0016
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROGER G TANS
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Credential | D.D.S.
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Telephone | 704-341-0016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 5189
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License Number State | NC
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