Basic Information
| Provider Information | |||||||||
| NPI: | 1568751816 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TANGLAO | ||||||||
| FirstName: | ELEANOR | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1955 W. TEXAS ST., | ||||||||
| Address2: | SUITE 12 | ||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7076034955 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1955 W TEXAS ST | ||||||||
| Address2: | SUITE 12 | ||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945334462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074285400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2011 | ||||||||
| LastUpdateDate: | 09/25/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 48190 | CA | Y | Dental Providers | Dentist | General Practice |
No ID Information.