Provider Demographics
NPI:1669722856
Name:TANN, RICHARD IAIN (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:IAIN
Last Name:TANN
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 1:1479 POPE STREET
Mailing Address - Street 2:
Mailing Address - City:LASALLE
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:N9J3R8
Mailing Address - Country:CA
Mailing Address - Phone:519-819-2555
Mailing Address - Fax:
Practice Address - Street 1:79 W ALEXANDRINE ST FL 3
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2015
Practice Address - Country:US
Practice Address - Phone:313-576-2551
Practice Address - Fax:313-576-2556
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901027391223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry