Provider Demographics
NPI:1053081372
Name:TANHA, NAZANIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:NAZANIN
Middle Name:
Last Name:TANHA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32837 HAYES RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-7367
Mailing Address - Country:US
Mailing Address - Phone:586-294-4710
Mailing Address - Fax:
Practice Address - Street 1:1080 CREEKWOOD TRL
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-1564
Practice Address - Country:US
Practice Address - Phone:810-743-4536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016010991223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health