Provider Demographics
NPI:1295744795
Name:TAN, MARIA TIU (DDS)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:TIU
Last Name:TAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8925 SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343
Mailing Address - Country:US
Mailing Address - Phone:818-894-8371
Mailing Address - Fax:818-894-8891
Practice Address - Street 1:8925 SEPULVEDA BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343
Practice Address - Country:US
Practice Address - Phone:818-894-8371
Practice Address - Fax:818-894-8891
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42617122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist