MEDICARE: TANNER JAMESON MITCHELL DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	12013213A	IN

General Provider Information

NPI Number	:	1730721499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANNER JAMESON MITCHELL DDS

Provider Business Mailing Address
First Line	:	3105 MIDDLE DR STE A
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47203-4472
Country	:	US
Telephone Number	:	317-656-0709
Fax Number	:	812-379-1977

Provider Business Practice Location Address
First Line	:	3105 MIDDLE DR STE A
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47203-4472
Country	:	US
Telephone Number	:	317-656-0709
Fax Number	:	812-379-1977

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2019
Last Update Date	:	10/15/2019

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