Provider Demographics
NPI:1790753804
Name:TANNYHILL, RICHARD JOHN JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JOHN
Last Name:TANNYHILL
Suffix:JR
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 1:836 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4408
Mailing Address - Country:US
Mailing Address - Phone:760-436-2890
Mailing Address - Fax:760-753-2084
Practice Address - Street 1:836 2ND ST
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4408
Practice Address - Country:US
Practice Address - Phone:760-436-2890
Practice Address - Fax:760-753-2084
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice