Provider Demographics
NPI:1780893081
Name:TANZ, BRIAN KEITH (DDS)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:KEITH
Last Name:TANZ
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:POB 16531769
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57186
Mailing Address - Country:US
Mailing Address - Phone:212-879-2277
Mailing Address - Fax:
Practice Address - Street 1:210 E 68TH ST
Practice Address - Street 2:SUITE 1-E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-6047
Practice Address - Country:US
Practice Address - Phone:212-879-2277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0411141223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics