Provider Demographics
NPI:1306981659
Name:VANORDEN, TARA LYNN (DMD)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:LYNN
Last Name:VANORDEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 KUENZLI ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1117
Mailing Address - Country:US
Mailing Address - Phone:775-329-5162
Mailing Address - Fax:775-334-4361
Practice Address - Street 1:1715 KUENZLI ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1117
Practice Address - Country:US
Practice Address - Phone:775-329-5162
Practice Address - Fax:775-334-4361
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000091931223D0001X
NV50861223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV004716904Medicaid