Provider Demographics
NPI:1982656344
Name:TANOORY, JASON ROBERT (DMD, FAGD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:ROBERT
Last Name:TANOORY
Suffix:
Gender:M
Credentials:DMD, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 SOUTH MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424
Mailing Address - Country:US
Mailing Address - Phone:585-394-1930
Mailing Address - Fax:585-394-1938
Practice Address - Street 1:329 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424
Practice Address - Country:US
Practice Address - Phone:585-394-1930
Practice Address - Fax:585-394-1938
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050001-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice