Healthcare Provider Details

I. General information

NPI: 1275217457
Provider Name (Legal Business Name): TANNER EMRING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2023
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1373 YMCA DR
FESTUS MO
63028-2617
US

IV. Provider business mailing address

6734 BRECKENRIDGE FARMS RD
DE SOTO MO
63020-5777
US

V. Phone/Fax

Practice location:
  • Phone: 636-541-7225
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2025024586
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: