Provider Demographics
NPI:1548879273
Name:DR. TANNOUS, DDS, LLC
Entity type:Organization
Organization Name:DR. TANNOUS, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:RAWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TANNOUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-717-4365
Mailing Address - Street 1:10775 ONYX DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-9494
Mailing Address - Country:US
Mailing Address - Phone:708-717-4365
Mailing Address - Fax:
Practice Address - Street 1:3965 W 106TH ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-7750
Practice Address - Country:US
Practice Address - Phone:708-717-4365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-29
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare