Provider Demographics
NPI:1154499473
Name:TAN, DEBBIE CARLOS (DDS)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:CARLOS
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 1:475 W. STETSON AVE #L
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-7044
Mailing Address - Country:US
Mailing Address - Phone:562-949-9437
Mailing Address - Fax:
Practice Address - Street 1:475 W STETSON AVE STE L
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-7073
Practice Address - Country:US
Practice Address - Phone:951-925-4002
Practice Address - Fax:951-925-4532
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice