Provider Demographics
NPI:1205824125
Name:TARANTINO, ERNEST EDWARD (DDS)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:EDWARD
Last Name:TARANTINO
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 1:283 JUNIPER RD
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303-6059
Mailing Address - Country:US
Mailing Address - Phone:970-385-5454
Mailing Address - Fax:970-385-5454
Practice Address - Street 1:283 JUNIPER RD
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-6059
Practice Address - Country:US
Practice Address - Phone:970-385-5454
Practice Address - Fax:970-385-5454
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8191122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist