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General NPI Number Information
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NPI Number | 1548413305
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Entity Type | Organization
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Legal Business Name | ELIZABETH TAN D.M.D.
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Dates
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Enumeration Date | 10/24/2008
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Last Update Date | 10/22/2014
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Provider Practice Location Address
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Address Line | 5270 NEWPARK PLZ
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City | NEWARK
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State | CA
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Zip | 94560-5221
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Country | US
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Telephone | 510-791-8118
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Fax | 510-797-8881
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Provider Business Mailing Address
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Address Line | 5270 NEWPARK PLZ
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City | NEWARK
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State | CA
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Zip | 94560-5221
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Country | US
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Telephone | 510-791-8118
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Fax | 510-797-8881
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Authorized Official
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Title or Position | INSURANCE COORDINATOR
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Name | MS. MAGGIE M TURAN
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Credential |
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Telephone | 510-791-8118
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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 |
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License Number State |
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