Provider Demographics
NPI:1720011745
Name:SHEILA TAN DDS, INC.
Entity Type:Organization
Organization Name:SHEILA TAN DDS, INC.
Other - Org Name:CAMINO DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:650-962-8773
Mailing Address - Street 1:1328 W EL CAMINO REAL # 1
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-2404
Mailing Address - Country:US
Mailing Address - Phone:650-962-8773
Mailing Address - Fax:650-962-8464
Practice Address - Street 1:1328 W EL CAMINO REAL # 1
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-2404
Practice Address - Country:US
Practice Address - Phone:650-962-8773
Practice Address - Fax:650-962-8464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42954122300000X
CA385081223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Multi-Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty