Provider Demographics
NPI:1174654966
Name:VLACANCICH, TANYA (DDS)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:
Last Name:VLACANCICH
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 1:1436 132ND ST
Mailing Address - Street 2:
Mailing Address - City:COLLEGE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11356-2046
Mailing Address - Country:US
Mailing Address - Phone:718-747-0020
Mailing Address - Fax:718-767-9613
Practice Address - Street 1:1436 132ND ST
Practice Address - Street 2:
Practice Address - City:COLLEGE POINT
Practice Address - State:NY
Practice Address - Zip Code:11356-2046
Practice Address - Country:US
Practice Address - Phone:718-747-0020
Practice Address - Fax:718-767-9613
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046705122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist