Provider Demographics
NPI:1871797639
Name:TANISAWA, ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:TANISAWA
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 1:22408 CHARLENE WAY
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-7102
Mailing Address - Country:US
Mailing Address - Phone:510-881-1922
Mailing Address - Fax:510-727-1583
Practice Address - Street 1:22408 CHARLENE WAY
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-7102
Practice Address - Country:US
Practice Address - Phone:510-881-1922
Practice Address - Fax:510-727-1583
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice