Provider Demographics
NPI: | 1790888295 |
---|---|
Name: | CURTIS K TANABE DDS LTD |
Entity Type: | Organization |
Organization Name: | CURTIS K TANABE DDS LTD |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | BUSINESS ADMIN |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | ANNE |
Authorized Official - Middle Name: | M |
Authorized Official - Last Name: | ZIMMER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 701-775-4751 |
Mailing Address - Street 1: | 1197 A SOUTH COLUMBIA RD |
Mailing Address - Street 2: | |
Mailing Address - City: | GRAND FORKS |
Mailing Address - State: | ND |
Mailing Address - Zip Code: | 58201-4033 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 701-775-4751 |
Mailing Address - Fax: | 701-746-4931 |
Practice Address - Street 1: | 1197 A SOUTH COLUMBIA RD |
Practice Address - Street 2: | |
Practice Address - City: | GRAND FORKS |
Practice Address - State: | ND |
Practice Address - Zip Code: | 58201-4033 |
Practice Address - Country: | US |
Practice Address - Phone: | 701-775-4751 |
Practice Address - Fax: | 701-746-4931 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-09-07 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
ND | 1557 | 122300000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 122300000X | Dental Providers | Dentist | Group - Single Specialty |