RANDALLWOOD DENTAL – NPI #1093160715
Clinic/Center

RANDALLWOOD DENTAL is an AHC clinic located in SAINT CHARLES, IL. NPPES has assigned the NPI number 1093160715 to RANDALLWOOD DENTAL on May 02, 2016. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “RANDALLWOOD DENTAL” is a dba name, the actual legal business name for this organization is TANQ 1, LTD.. The primary taxonomy selected by this provider is 261QD0000X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Dental

The NPI profile was previously updated about 5 years ago on Jun 09, 2021. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for RANDALLWOOD DENTAL below.

NPI Profile for
TANQ 1, LTD.

NPI Number
1093160715
Enumeration Date

(more than 10 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
TANQ 1, LTD.
Doing Business As (dba): RANDALLWOOD DENTAL
Primary location
1546 EAST MAIN ST.
SAINT CHARLES, IL 60174
Phone: (630) 377-0034 Fax: (630) 377-3877
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
RENE TANQUILUT
PRESIDENT / OWNER
Phone: (630) 377-0034
Updated
Certification Date
Jun 09, 2021

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QD0000X
- Clinic/Center / Dental (Primary)		 IL 019023351

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.