Provider Demographics
NPI:1568947513
Name:STRELOW, TANISHA RAQUEL (RDH)
Entity Type:Individual
Prefix:MS
First Name:TANISHA
Middle Name:RAQUEL
Last Name:STRELOW
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 MARQUETTE AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-1376
Mailing Address - Country:US
Mailing Address - Phone:231-660-3888
Mailing Address - Fax:231-737-1724
Practice Address - Street 1:2201 S GETTY ST. MUSKEGON, HEIGHTS MICHIGAN
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-4944
Practice Address - Country:US
Practice Address - Phone:231-737-1711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902018703124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist