Provider Demographics
NPI:1104955160
Name:TANANIS, RICHARD J (DDS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:TANANIS
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 1:30599 SUSSEX HWY
Mailing Address - Street 2:UNIT #3
Mailing Address - City:LAUREL
Mailing Address - State:DE
Mailing Address - Zip Code:19956-4417
Mailing Address - Country:US
Mailing Address - Phone:302-875-4271
Mailing Address - Fax:302-875-9441
Practice Address - Street 1:30599 SUSSEX HWY
Practice Address - Street 2:UNIT #3
Practice Address - City:LAUREL
Practice Address - State:DE
Practice Address - Zip Code:19956-4417
Practice Address - Country:US
Practice Address - Phone:302-875-4271
Practice Address - Fax:302-875-9441
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-00011341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice