Provider Demographics
NPI:1497884357
Name:RICHARD J. TANANIS, D.D.S., L.L.C.
Entity Type:Organization
Organization Name:RICHARD J. TANANIS, D.D.S., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:TANANIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:302-875-4271
Mailing Address - Street 1:30599 SUSSEX HWY
Mailing Address - Street 2:UNIT #3
Mailing Address - City:LAUREL
Mailing Address - State:DE
Mailing Address - Zip Code:19956-4417
Mailing Address - Country:US
Mailing Address - Phone:302-875-4271
Mailing Address - Fax:302-875-9441
Practice Address - Street 1:30599 SUSSEX HWY
Practice Address - Street 2:UNIT #3
Practice Address - City:LAUREL
Practice Address - State:DE
Practice Address - Zip Code:19956-4417
Practice Address - Country:US
Practice Address - Phone:302-875-4271
Practice Address - Fax:302-875-9441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE20052102381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty