Provider Demographics
NPI:1518183003
Name:S. TANI, A DENTAL CORPORATION
Entity Type:Organization
Organization Name:S. TANI, A DENTAL CORPORATION
Other - Org Name:MELROSE SQUARE DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:TANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-727-6800
Mailing Address - Street 1:1680 S MELROSE DR
Mailing Address - Street 2:#108
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-5472
Mailing Address - Country:US
Mailing Address - Phone:760-727-6800
Mailing Address - Fax:
Practice Address - Street 1:1680 S MELROSE DR
Practice Address - Street 2:#108
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-5472
Practice Address - Country:US
Practice Address - Phone:760-727-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA326221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty