Provider Demographics
NPI:1689686628
Name:TANQUILUT, RENE (DDS)
Entity type:Individual
Prefix:DR
First Name:RENE
Middle Name:
Last Name:TANQUILUT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 S CLAY ST
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-4033
Mailing Address - Country:US
Mailing Address - Phone:708-790-2169
Mailing Address - Fax:
Practice Address - Street 1:1113 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1803
Practice Address - Country:US
Practice Address - Phone:708-790-2169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019023351122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist