Healthcare Provider Details

I. General information

NPI: 1700438793
Provider Name (Legal Business Name): TANNER DAHL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4888 N STONE AVE UNIT 120
TUCSON AZ
85704-5749
US

IV. Provider business mailing address

4888 N STONE AVE UNIT 120
TUCSON AZ
85704-5749
US

V. Phone/Fax

Practice location:
  • Phone: 520-670-3909
  • Fax: 520-309-2560
Mailing address:
  • Phone: 520-670-3909
  • Fax: 520-309-2560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60967449
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE60967449
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD012788
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: