Healthcare Provider Details

I. General information

NPI: 1508234766
Provider Name (Legal Business Name): DAVID A TANNER DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2015
Last Update Date: 09/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22800 LYONS AVE STE 200
NEWHALL CA
91321-2898
US

IV. Provider business mailing address

22800 LYONS AVE STE 200
NEWHALL CA
91321-2898
US

V. Phone/Fax

Practice location:
  • Phone: 661-254-1884
  • Fax:
Mailing address:
  • Phone: 661-254-1884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30463
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID TANNER
Title or Position: OWNER
Credential: DDS
Phone: 66122541884