Provider Demographics
NPI:1801006879
Name:HWYNN, TANI (DMD)
Entity Type:Individual
Prefix:DR
First Name:TANI
Middle Name:
Last Name:HWYNN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5726 E ROCKING HORSE WAY
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-4320
Mailing Address - Country:US
Mailing Address - Phone:714-901-0190
Mailing Address - Fax:
Practice Address - Street 1:14550 MAGNOLIA ST
Practice Address - Street 2:SUITE 103
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5565
Practice Address - Country:US
Practice Address - Phone:714-901-0190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA441871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice