Provider Demographics
NPI:1700066230
Name:TADEO, ENMER ISAU (DDS)
Entity Type:Individual
Prefix:DR
First Name:ENMER
Middle Name:ISAU
Last Name:TADEO
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 1:2873 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-6226
Mailing Address - Country:US
Mailing Address - Phone:714-761-7000
Mailing Address - Fax:714-761-3900
Practice Address - Street 1:2873 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-6226
Practice Address - Country:US
Practice Address - Phone:714-761-7000
Practice Address - Fax:714-761-3900
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56591122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist