Provider Demographics
NPI:1073834248
Name:TAGONI, JAMES R (DMD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:TAGONI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 TOWER TERRACE RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-8975
Mailing Address - Country:US
Mailing Address - Phone:319-366-8277
Mailing Address - Fax:
Practice Address - Street 1:835 3RD AVE SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-2407
Practice Address - Country:US
Practice Address - Phone:319-366-8277
Practice Address - Fax:319-366-7091
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA141168204E00000X
FLDN222981223S0112X
MADL-10923204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IADDS-09834OtherSTATE LICENSE