Active NPI
Renz Anthony Tan Antonio, DDS
- Prosthodontics
- San Diego, CA
National Provider Identifier
1306407267
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 103836
- Practice address
- 34800 Bob Wilson Dr
San Diego, CA 92134-2111 - Phone
- (619) 532-8600
- NPI assigned
- Jun 21, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 103836 | CA | |
| Prosthodontics | 1223P0700X | 103836 | CA | Primary |
Addresses
Primary practice location
34800 Bob Wilson Dr
San Diego, CA 92134-2111
Mailing address
70 Empire CT
Mountain View, CA 94040-1591
Other practice location 1
620 John Paul Jones Cir
Portsmouth, VA 23708-2111
Phone (757) 953-2711
Other practice location 2
8955 Wood Rd Bldg 1
Bethesda, MD 20889-2111
Phone (301) 295-1550
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 103836 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1561075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723420800000",
"number": "1306407267",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "70 EMPIRE CT",
"city": "MOUNTAIN VIEW",
"state": "CA",
"postal_code": "940401591"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "34800 BOB WILSON DR",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921342111",
"telephone_number": "619-532-8600"
}
],
"practiceLocations": [
{
"address_1": "620 John Paul Jones Cir",
"address_purpose": "LOCATION",
"city": "Portsmouth",
"state": "VA",
"postal_code": "237082111",
"country_code": "US",
"telephone_number": "757-953-2711",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "8955 Wood Rd Bldg 1",
"address_purpose": "LOCATION",
"city": "Bethesda",
"state": "MD",
"postal_code": "208892111",
"country_code": "US",
"telephone_number": "301-295-1550",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ANTONIO",
"first_name": "RENZ ANTHONY",
"middle_name": "TAN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-06-21",
"last_updated": "2024-08-12",
"certification_date": "2024-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "103836",
"primary": false
},
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "CA",
"license": "103836",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.