Provider Demographics
NPI:1518520675
Name:TAN, ROBERT W (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:TAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3D DENTAL IMPLANT CENTER
Mailing Address - Street 2:5321 7TH AVENUE
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220
Mailing Address - Country:US
Mailing Address - Phone:201-855-9493
Mailing Address - Fax:
Practice Address - Street 1:3D DENTAL IMPLANT CENTER
Practice Address - Street 2:5321 7TH AVENUE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220
Practice Address - Country:US
Practice Address - Phone:718-576-3187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-15
Last Update Date:2020-10-20
Deactivation Date:2020-08-07
Deactivation Code:
Reactivation Date:2020-08-14
Provider Licenses
StateLicense IDTaxonomies
NY0611681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty