Provider Demographics
NPI:1144604810
Name:CANONGE, TANGUY (DDS)
Entity Type:Individual
Prefix:MR
First Name:TANGUY
Middle Name:
Last Name:CANONGE
Suffix:
Gender:M
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:ONE KNEELAND STREET, 11TH FLOOR (ORTHODONTICS)
Mailing Address - Street 2:TUFTS UNIVERSITY SCHOOL OF DENTAL MEDICINE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111
Mailing Address - Country:US
Mailing Address - Phone:617-636-3471
Mailing Address - Fax:
Practice Address - Street 1:ONE KNEELAND STREET, 11TH FLOOR (ORTHODONTICS)
Practice Address - Street 2:TUFTS UNIVERSITY SCHOOL OF DENTAL MEDICINE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111
Practice Address - Country:US
Practice Address - Phone:617-636-3471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2016-03-22
Deactivation Date:2016-03-04
Deactivation Code:
Reactivation Date:2016-03-22
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program