Provider Demographics
NPI:1023189636
Name:PAUL TANNENBAUM PA
Entity Type:Organization
Organization Name:PAUL TANNENBAUM PA
Other - Org Name:PAUL TANNENBAUM DDS PA
Other - Org Type:Other Name
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:TANNENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-596-2815
Mailing Address - Street 1:9777 SW 72ND STREET
Mailing Address - Street 2:PAUL TANNENBAUM DDS PA
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173
Mailing Address - Country:US
Mailing Address - Phone:305-596-2815
Mailing Address - Fax:
Practice Address - Street 1:9777 SW 72ND STREET
Practice Address - Street 2:PAUL TANNENBAUM DDS PA
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173
Practice Address - Country:US
Practice Address - Phone:305-596-2815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN70181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty