Provider Demographics
NPI:1992783054
Name:VAN, TAN H (DDS)
Entity type:Individual
Prefix:DR
First Name:TAN
Middle Name:H
Last Name:VAN
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 1:22038 W 66TH ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66226-3500
Mailing Address - Country:US
Mailing Address - Phone:913-441-9553
Mailing Address - Fax:913-441-9559
Practice Address - Street 1:22038 W 66TH ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66226-3500
Practice Address - Country:US
Practice Address - Phone:913-441-9553
Practice Address - Fax:913-441-9559
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60033122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist