Provider Demographics
NPI:1932716362
Name:TASKER AND ROWAN DENTAL CORPORATION
Entity Type:Organization
Organization Name:TASKER AND ROWAN DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:GANON
Authorized Official - Last Name:ROWAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-227-4563
Mailing Address - Street 1:530 W 21ST ST STE B
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-3719
Mailing Address - Country:US
Mailing Address - Phone:209-580-4685
Mailing Address - Fax:866-788-6202
Practice Address - Street 1:500 S ANAHEIM HILLS RD STE 116
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-4762
Practice Address - Country:US
Practice Address - Phone:209-580-4685
Practice Address - Fax:866-788-6202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty