Individual
JUSTIN TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1057 12TH AVE, LONGVIEW, WA 98632-2509
(360) 414-1300
Mailing address
1057 12TH AVE, LONGVIEW, WA 98632-2509
(360) 414-1300
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE60502542
WA
Other
Enumeration date
12/03/2014
Last updated
12/03/2014
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