Provider Demographics
NPI:1306285838
Name:NIELSEN, TANYA LYNNE (DDS)
Entity type:Individual
Prefix:DR
First Name:TANYA
Middle Name:LYNNE
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13444 VERONA
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-9149
Mailing Address - Country:US
Mailing Address - Phone:714-389-2519
Mailing Address - Fax:
Practice Address - Street 1:2990 S 6TH AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-4705
Practice Address - Country:US
Practice Address - Phone:520-777-9658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0087221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice