MEDICARE: EDUARDO TANUR D.D.S.

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	1223P0300X	Periodontics	19473	TX

General Provider Information

NPI Number	:	1568595502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDUARDO TANUR D.D.S.

Provider Business Mailing Address
First Line	:	2701 WESTMORELAND DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-3114
Country	:	US
Telephone Number	:	972-596-6954
Fax Number	:	972-596-6954

Provider Business Practice Location Address
First Line	:	8722 GREENVILLE AVE STE 100
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-7165
Country	:	US
Telephone Number	:	214-503-1000
Fax Number	:	214-503-1003

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

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	07/08/2007

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