Provider Demographics
NPI:1265752042
Name:TANGUAY, JASON A (DDS)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:A
Last Name:TANGUAY
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 1:105 E OAK ST STE 2A
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-2978
Mailing Address - Country:US
Mailing Address - Phone:406-600-1939
Mailing Address - Fax:
Practice Address - Street 1:105 E OAK ST STE 2A
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-2978
Practice Address - Country:US
Practice Address - Phone:406-586-5880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT24521223G0001X
WADR60145261122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist