Healthcare Provider Details

I. General information

NPI: 1144114851
Provider Name (Legal Business Name): TANNER WILLIAM LOTEMPIO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

H200 MERCY CIRCLE
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

H200 MERCY CIRCLE
CAMP PENDLETON CA
92055
US

V. Phone/Fax

Practice location:
  • Phone: 760-719-3236
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2025027788
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: