Provider Demographics
NPI:1346751799
Name:TANZELLA, JUDITH (RDH)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:TANZELLA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 COLON ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-3604
Mailing Address - Country:US
Mailing Address - Phone:978-921-6060
Mailing Address - Fax:
Practice Address - Street 1:7 SOHIER RD
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-3415
Practice Address - Country:US
Practice Address - Phone:978-921-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADH9706124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist