Provider Demographics
NPI:1366750655
Name:TANGEMAN, SCOTT A (DDS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:TANGEMAN
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 1:5500 MING AVE
Mailing Address - Street 2:SUITE 165
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-4689
Mailing Address - Country:US
Mailing Address - Phone:661-835-8785
Mailing Address - Fax:
Practice Address - Street 1:5500 MING AVE
Practice Address - Street 2:SUITE 165
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-4689
Practice Address - Country:US
Practice Address - Phone:661-835-8785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2013-09-11
Deactivation Date:2010-09-28
Deactivation Code:
Reactivation Date:2013-09-11
Provider Licenses
StateLicense IDTaxonomies
CA0318701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice