Stephanie Tan

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

12013876A Issued in IN

Practice address

2347 Cason St
Lafayette, IN 47904-2670

Phone

(765) 447-6808

NPI assigned

Jul 23, 2020

Last updated

Jul 28, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lafayette Pediatric Dentistry & Orthodontics

  • Dentist
  • Lafayette, IN
  • NPI 1477869378
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1595462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658966400000",
    "number": "1326657511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "326 DOUBLE TREE DR",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479058909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2347 CASON ST",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479042670",
            "telephone_number": "765-447-6808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAN",
        "first_name": "STEPHANIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-23",
        "last_updated": "2022-07-28",
        "certification_date": "2022-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IN",
            "license": "12013876A",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Szendrey
• Michelle L Tabor, CFA
• Dena Rae Tackett, OT
• Sarah Nicole Tackett
• Nicholas Nasry Tadros, MD
• Yuanyuan Tan, MD
• James R Tanner, O.D.
• Alvin Heng Tao, MD
• Dianne Lynn Tao, WHNP
• Jocelyn Tao, PHARM D

• Pediatric Dentistry in Lafayette, IN
• Providers in Lafayette, IN by specialty
• Pediatric Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.