Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 2901601099 | MI |
NPI | 1053081372 |
---|---|
Provider Name | Dr. Nazanin Tanha |
First Address | Warren, MI 48088-7367 |
Second Address | Burton, MI 48509-1564 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2021 |
Last Update Date | 17/09/2021 |