Provider Demographics
NPI:1801400338
Name:TANTY FAMILY DENTAL
Entity Type:Organization
Organization Name:TANTY FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-542-8382
Mailing Address - Street 1:W249S3642 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189-7364
Mailing Address - Country:US
Mailing Address - Phone:262-542-8382
Mailing Address - Fax:262-542-9602
Practice Address - Street 1:W249S3642 CENTER RD
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53189-7364
Practice Address - Country:US
Practice Address - Phone:262-542-8382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental