Individual
STEPHANIE TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2347 CASON ST, LAFAYETTE, IN 47904-2670
(765) 447-6808
Mailing address
326 DOUBLE TREE DR, LAFAYETTE, IN 47905-8909
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
12013876A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/23/2020
Last updated
07/28/2022
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