MEDICARE: DR. MARY COLLEEN TANDON 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	122300000X	Dentist	59754	CA
2	1223D0001X	Public Health Dentistry	08724	IA
3	1223G0001X	General Practice Dentistry	08724	IA
4	1223G0001X	General Practice Dentistry	D008538	AZ

General Provider Information

NPI Number	:	1841502523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY COLLEEN TANDON D.D.S.

Provider Business Mailing Address
First Line	:	PSC 808 BOX 19
Second Line	:
City	:	FPO
State	:	AE
Zip	:	09618-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	U.S. NAVAL HOSPITAL
Second Line	:	VIA CONTRADA BOSCARIELLO
City	:	GRICIGNANO DI AVERSA
State	:	CE
Zip	:	81030
Country	:	IT
Telephone Number	:
Fax Number	:

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

Provider Enumeration Date	:	07/09/2010
Last Update Date	:	03/25/2026

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