Provider Demographics
NPI:1306991807
Name:DENNIS L TANK DDS PC
Entity type:Organization
Organization Name:DENNIS L TANK DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:TANK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-985-0300
Mailing Address - Street 1:475 W CHANNEL ISLANDS BLVD
Mailing Address - Street 2:203
Mailing Address - City:PORT HUENEME
Mailing Address - State:CA
Mailing Address - Zip Code:93041
Mailing Address - Country:US
Mailing Address - Phone:805-985-0300
Mailing Address - Fax:
Practice Address - Street 1:475 W CHANNEL ISLANDS BLVD
Practice Address - Street 2:203
Practice Address - City:PORT HUENEME
Practice Address - State:CA
Practice Address - Zip Code:93041
Practice Address - Country:US
Practice Address - Phone:805-985-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21068122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTIN STATE OF CALIF