Provider Demographics
NPI:1578643110
Name:TANS, ROGER G (DDS)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:G
Last Name:TANS
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 1:3121 SPRINGBANK LN
Mailing Address - Street 2:SUITE D
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-3346
Mailing Address - Country:US
Mailing Address - Phone:704-341-0016
Mailing Address - Fax:
Practice Address - Street 1:3121 SPRINGBANK LN
Practice Address - Street 2:SUITE D
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3346
Practice Address - Country:US
Practice Address - Phone:704-341-0016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC51891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice