Provider Demographics
NPI:1093840217
Name:TAHANI, ROBERT (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:TAHANI
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 1:4519 CASTLE RD
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-1451
Mailing Address - Country:US
Mailing Address - Phone:818-248-7344
Mailing Address - Fax:818-248-1857
Practice Address - Street 1:4519 CASTLE RD
Practice Address - Street 2:
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-1451
Practice Address - Country:US
Practice Address - Phone:818-248-7344
Practice Address - Fax:818-248-1857
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA546301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice