Provider Demographics
NPI:1134285489
Name:TAN, PAUL B (DMD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:B
Last Name:TAN
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 1:100 BUSH ST
Mailing Address - Street 2:SUITE 1475
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104
Mailing Address - Country:US
Mailing Address - Phone:415-438-7929
Mailing Address - Fax:415-438-7926
Practice Address - Street 1:100 BUSH STREET
Practice Address - Street 2:SUITE 1475
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104
Practice Address - Country:US
Practice Address - Phone:415-438-7929
Practice Address - Fax:415-438-7926
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39715122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist