Healthcare Provider Details

I. General information

NPI: 1760226047
Provider Name (Legal Business Name): TANNER NELSON, DDS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 1ST AVE N
GREAT FALLS MT
59401-2606
US

IV. Provider business mailing address

3235 5TH AVE S
GREAT FALLS MT
59405-3339
US

V. Phone/Fax

Practice location:
  • Phone: 406-661-9313
  • Fax:
Mailing address:
  • Phone: 406-661-9313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: TANNER NELSON
Title or Position: OWNER
Credential: DDS
Phone: 406-661-9313