Provider Demographics
NPI:1134353014
Name:TARTAGLIA, DAVID (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:TARTAGLIA
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 1:13510 JULIE DR
Mailing Address - Street 2:
Mailing Address - City:POPLAR GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:61065-7829
Mailing Address - Country:US
Mailing Address - Phone:815-765-9900
Mailing Address - Fax:815-765-9901
Practice Address - Street 1:13510 JULIE DR
Practice Address - Street 2:
Practice Address - City:POPLAR GROVE
Practice Address - State:IL
Practice Address - Zip Code:61065-7829
Practice Address - Country:US
Practice Address - Phone:815-765-9900
Practice Address - Fax:815-765-9901
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190255991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice