Healthcare Provider Details

I. General information

NPI: 1932766193
Provider Name (Legal Business Name): TANNER GOODMAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2019
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4727 E. PECOS RD. SUITE 101
GILBERT AZ
85295
US

IV. Provider business mailing address

4727 E. PECOS RD. SUITE 101
GILBERT AZ
85295
US

V. Phone/Fax

Practice location:
  • Phone: 480-807-4000
  • Fax:
Mailing address:
  • Phone: 480-807-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD010329
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: