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General NPI Number Information
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NPI Number | 1386805729
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Entity Type | Organization
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Legal Business Name | TAN H. VAN, DDS, P.A.
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Dates
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Enumeration Date | 06/18/2008
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 22038 W 66TH ST
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City | SHAWNEE
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State | KS
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Zip | 66226-3500
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Country | US
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Telephone | 913-441-9553
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Fax | 913-441-9559
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Provider Business Mailing Address
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Address Line | 23519 W 46TH ST
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City | SHAWNEE
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State | KS
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Zip | 66226-2508
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Country | US
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Telephone | 913-441-9553
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Fax | 913-441-9559
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TAN H. VAN
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Credential | DDS
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Telephone | 913-441-9553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 60033
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License Number State | KS
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