Provider Demographics
NPI:1568751816
Name:TANGLAO, ELEANOR R (DDS)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:R
Last Name:TANGLAO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 W. TEXAS ST.,
Mailing Address - Street 2:SUITE 12
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533
Mailing Address - Country:US
Mailing Address - Phone:707-603-4955
Mailing Address - Fax:
Practice Address - Street 1:1955 W TEXAS ST
Practice Address - Street 2:SUITE 12
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-4462
Practice Address - Country:US
Practice Address - Phone:707-428-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA481901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice