Provider Demographics
NPI:1043459738
Name:TANGERINE DENTAL GROUP, LLP
Entity Type:Organization
Organization Name:TANGERINE DENTAL GROUP, LLP
Other - Org Name:TANGERINE DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTRACTS ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:REAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-544-5590
Mailing Address - Street 1:2860 MICHELLE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-1009
Mailing Address - Country:US
Mailing Address - Phone:714-368-2077
Mailing Address - Fax:714-368-2092
Practice Address - Street 1:1880 EAST TANGERINE ROAD
Practice Address - Street 2:SUITE 190
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755
Practice Address - Country:US
Practice Address - Phone:520-544-5590
Practice Address - Fax:520-297-3052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty