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General NPI Number Information
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NPI Number | 1568947513
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Entity Type | Individual
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Provider Name | TANISHA RAQUEL STRELOW RDH
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Gender | Female
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Dates
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Enumeration Date | 09/26/2018
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Last Update Date | 09/26/2018
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Provider Practice Location Address
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Address Line | 2201 S GETTY ST. MUSKEGON, HEIGHTS MICHIGAN
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City | MUSKEGON
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State | MI
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Zip | 49444-4944
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Country | US
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Telephone | 231-737-1711
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Fax |
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Provider Business Mailing Address
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Address Line | 935 MARQUETTE AVE
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City | MUSKEGON
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State | MI
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Zip | 49442-1376
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Country | US
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Telephone | 231-660-3888
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Fax | 231-737-1724
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 2902018703
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License Number State | MI
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