Provider Demographics
NPI:1164858361
Name:JASON TANGUAY, DDS, LLC
Entity Type:Organization
Organization Name:JASON TANGUAY, DDS, LLC
Other - Org Name:MINT DENTAL STUDIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:TANGUAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:406-586-5880
Mailing Address - Street 1:40 E MENDENHALL ST
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-3631
Mailing Address - Country:US
Mailing Address - Phone:406-586-5880
Mailing Address - Fax:406-586-5881
Practice Address - Street 1:40 E MENDENHALL ST
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3631
Practice Address - Country:US
Practice Address - Phone:406-586-5880
Practice Address - Fax:406-586-5881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty