Provider Demographics
NPI:1639423213
Name:TANASE, EMIL (DDS)
Entity Type:Individual
Prefix:DR
First Name:EMIL
Middle Name:
Last Name:TANASE
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 1:5808 CANARY DR
Mailing Address - Street 2:
Mailing Address - City:NORTH HIGHLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:95660-4705
Mailing Address - Country:US
Mailing Address - Phone:916-949-4949
Mailing Address - Fax:
Practice Address - Street 1:3031 W MARCH LANE
Practice Address - Street 2:STE 318E
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219
Practice Address - Country:US
Practice Address - Phone:916-949-4949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-02
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61838122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist