Provider Demographics
NPI:1235247446
Name:TENNANT & TWARGOSKI DMDS PA
Entity Type:Organization
Organization Name:TENNANT & TWARGOSKI DMDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:TWARGOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:941-493-5495
Mailing Address - Street 1:1258 JACARANDA BLVD
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293
Mailing Address - Country:US
Mailing Address - Phone:941-493-5495
Mailing Address - Fax:941-493-2455
Practice Address - Street 1:1258 JACARANDA BLVD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293
Practice Address - Country:US
Practice Address - Phone:941-493-5495
Practice Address - Fax:941-493-2455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN137251223G0001X
FLDN135451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty