Provider Demographics
NPI:1790792919
Name:TANANA, GREGORY M (DDS)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:M
Last Name:TANANA
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:PO BOX 205
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02334-0205
Mailing Address - Country:US
Mailing Address - Phone:508-238-4265
Mailing Address - Fax:508-230-2451
Practice Address - Street 1:523 FOUNDRY STREET
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MA
Practice Address - Zip Code:02334
Practice Address - Country:US
Practice Address - Phone:508-238-4265
Practice Address - Fax:508-230-2451
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA129591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice