Provider Demographics
NPI:1679251276
Name:THARANI, TANYA
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:THARANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3341 MOUNTAINSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-8916
Mailing Address - Country:US
Mailing Address - Phone:949-232-7944
Mailing Address - Fax:
Practice Address - Street 1:131 W ONTARIO AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-5274
Practice Address - Country:US
Practice Address - Phone:951-898-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS110677122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist