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General NPI Number Information
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NPI Number | 1932627494
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Entity Type | Individual
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Provider Name | MR. DENNIS J TAN
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Gender | Male
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Dates
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Enumeration Date | 09/05/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 6979 W CACTUS WREN DR
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City | GLENDALE
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State | AZ
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Zip | 85303-2684
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Country | US
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Telephone | 623-915-5491
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Fax | 623-915-5491
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Provider Business Mailing Address
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Address Line | 6979 W CACTUS WREN DR
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City | GLENDALE
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State | AZ
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Zip | 85303-2684
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Country | US
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Telephone | 623-915-5491
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Fax | 623-915-5491
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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 | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL9624H
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License Number State | AZ
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