Provider Demographics
NPI:1083763585
Name:TAN, JO-ANNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JO-ANNA
Middle Name:
Last Name:TAN
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 1:12677 NW WAKER DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-3707
Mailing Address - Country:US
Mailing Address - Phone:503-439-0605
Mailing Address - Fax:
Practice Address - Street 1:2350 SW MULTNOMAH BLVD STE G
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-3999
Practice Address - Country:US
Practice Address - Phone:503-307-7700
Practice Address - Fax:503-546-5327
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2008-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD8104122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist