MEDICARE: DR. JAMES EMMANUEL TANGALOS DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2901600535	MI

General Provider Information

NPI Number	:	1174184055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES EMMANUEL TANGALOS DMD

Provider Business Mailing Address
First Line	:	51540 VAN DYKE AVE
Second Line	:
City	:	SHELBY TWP
State	:	MI
Zip	:	48316-4446
Country	:	US
Telephone Number	:	586-265-2004
Fax Number	:

Provider Business Practice Location Address
First Line	:	21055 E 12 MILE RD
Second Line	:
City	:	ROSEVILLE
State	:	MI
Zip	:	48066-2205
Country	:	US
Telephone Number	:	586-789-9528
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2019
Last Update Date	:	01/11/2026

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