Provider Demographics
NPI:1881967644
Name:DEBBIE C. TAN, DDS, INC.
Entity type:Organization
Organization Name:DEBBIE C. TAN, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:TAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-925-4002
Mailing Address - Street 1:475 W STETSON AVE
Mailing Address - Street 2:SUITE #L
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-7070
Mailing Address - Country:US
Mailing Address - Phone:951-925-4002
Mailing Address - Fax:951-925-4532
Practice Address - Street 1:475 W STETSON AVE
Practice Address - Street 2:SUITE #L
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-7070
Practice Address - Country:US
Practice Address - Phone:951-925-4002
Practice Address - Fax:951-925-4532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty