Provider Demographics
NPI:1245330836
Name:TANEGA, JANET REPANE (DMD)
Entity type:Individual
Prefix:DR
First Name:JANET
Middle Name:REPANE
Last Name:TANEGA
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 1:17 PINE VALLEY PL
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-9118
Mailing Address - Country:US
Mailing Address - Phone:925-803-6998
Mailing Address - Fax:650-794-1909
Practice Address - Street 1:124 HAZELWOOD DR
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-5720
Practice Address - Country:US
Practice Address - Phone:650-794-0203
Practice Address - Fax:650-794-1909
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA434011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice