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General NPI Number Information
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NPI Number | 1174184055
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Entity Type | Individual
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Provider Name | JAMES EMMANUEL TANGALOS DMD
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Gender | Male
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Dates
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Enumeration Date | 06/22/2019
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Last Update Date | 01/11/2026
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Provider Practice Location Address
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Address Line | 21055 E 12 MILE RD
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City | ROSEVILLE
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State | MI
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Zip | 48066-2205
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Country | US
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Telephone | 586-789-9528
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Fax |
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Provider Business Mailing Address
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Address Line | 51540 VAN DYKE AVE
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City | SHELBY TWP
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State | MI
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Zip | 48316-4446
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Country | US
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Telephone | 586-265-2004
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901600535
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License Number State | MI
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