Provider Demographics
NPI:1467826297
Name:DANIEL TANITA, DDS INC
Entity Type:Organization
Organization Name:DANIEL TANITA, DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DANILE
Authorized Official - Middle Name:
Authorized Official - Last Name:TANITA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-236-1661
Mailing Address - Street 1:2089 VALE RD STE 30
Mailing Address - Street 2:
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-3847
Mailing Address - Country:US
Mailing Address - Phone:510-236-1661
Mailing Address - Fax:510-236-6380
Practice Address - Street 1:2089 VALE RD STE 30
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3847
Practice Address - Country:US
Practice Address - Phone:510-236-1661
Practice Address - Fax:510-236-6380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty