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General NPI Number Information
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NPI Number | 1801400338
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Entity Type | Organization
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Legal Business Name | TANTY FAMILY DENTAL
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Dates
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Enumeration Date | 09/02/2020
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Last Update Date | 09/02/2020
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Provider Practice Location Address
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Address Line | W249S3642 CENTER RD
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City | WAUKESHA
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State | WI
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Zip | 53189-7364
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Country | US
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Telephone | 262-542-8382
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Fax |
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Provider Business Mailing Address
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Address Line | W249S3642 CENTER RD
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City | WAUKESHA
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State | WI
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Zip | 53189-7364
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Country | US
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Telephone | 262-542-8382
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Fax | 262-542-9602
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. MEGAN BUSKO
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Credential |
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Telephone | 262-542-8382
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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