Provider Demographics
NPI:1093010779
Name:TANEGA, RONALD GREEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:GREEN
Last Name:TANEGA
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 1:377 LONDON ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-2725
Mailing Address - Country:US
Mailing Address - Phone:415-412-5934
Mailing Address - Fax:
Practice Address - Street 1:377 LONDON ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-2725
Practice Address - Country:US
Practice Address - Phone:415-412-5934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57589122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist