Healthcare Provider Details

I. General information

NPI: 1386562528
Provider Name (Legal Business Name): TANNER DICE, DMD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 ED DR STE 120
RALEIGH NC
27612-8097
US

IV. Provider business mailing address

3840 ED DR STE 120
RALEIGH NC
27612-8097
US

V. Phone/Fax

Practice location:
  • Phone: 859-432-0047
  • Fax:
Mailing address:
  • Phone: 859-432-0047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TANNER DICE
Title or Position: OWNER
Credential: DMD
Phone: 859-432-0047