Healthcare Provider Details

I. General information

NPI: 1275186231
Provider Name (Legal Business Name): TANNER AND MONAGHAN, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2019
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 BENJAMIN PKWY
GREENSBORO NC
27408-2015
US

IV. Provider business mailing address

1602 BENJAMIN PKWY
GREENSBORO NC
27408-2015
US

V. Phone/Fax

Practice location:
  • Phone: 336-545-9084
  • Fax: 336-545-5679
Mailing address:
  • Phone: 336-545-9084
  • Fax: 336-545-5679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: EUGENIA T MONAGHAN
Title or Position: PERIODONTIST
Credential: DMD
Phone: 336-545-9084