Organization
TANQ 1, LTD.
Active
Other names
Randallwood Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RENE TANQUILUT D.D.S. (PRESIDENT / OWNER)
(630) 377-0034
Entity
Organization
Contact information
Practice address
1546 EAST MAIN ST., ST CHARLES, IL 60174
(630) 377-0034
(630) 377-3877
Mailing address
1546 EAST MAIN ST., ST CHARLES, IL 60174
(630) 377-0034
(630) 377-3877
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
019023351
IL
Other
Enumeration date
05/02/2016
Last updated
06/09/2021
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