Provider Demographics
NPI:1174184055
Name:TANGALOS, JAMES EMMANUEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EMMANUEL
Last Name:TANGALOS
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 1:21055 E 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-2205
Mailing Address - Country:US
Mailing Address - Phone:586-789-9528
Mailing Address - Fax:
Practice Address - Street 1:21055 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-2205
Practice Address - Country:US
Practice Address - Phone:586-789-9528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-22
Last Update Date:2020-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2951000774122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist