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General NPI Number Information
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NPI Number | 1306991807
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Entity Type | Organization
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Legal Business Name | DENNIS L TANK DDS PC
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 475 W CHANNEL ISLANDS BLVD 203
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City | PORT HUENEME
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State | CA
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Zip | 93041
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Country | US
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Telephone | 805-985-0300
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Fax |
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Provider Business Mailing Address
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Address Line | 475 W CHANNEL ISLANDS BLVD 203
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City | PORT HUENEME
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State | CA
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Zip | 93041
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Country | US
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Telephone | 805-985-0300
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Fax |
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Authorized Official
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Title or Position | PRES OWNER
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Name | DR. DENNIS LANE TANK
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Credential | DDS
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Telephone | 805-985-0300
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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 | 21068
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License Number State | CA
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