Healthcare Provider Details

I. General information

NPI: 1679001093
Provider Name (Legal Business Name): TANNER HUNSAKER DDS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 N 200 E
LOGAN UT
84321-4488
US

IV. Provider business mailing address

290 N 200 E
LOGAN UT
84321-4488
US

V. Phone/Fax

Practice location:
  • Phone: 435-760-7903
  • Fax:
Mailing address:
  • Phone: 435-760-7903
  • 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: TANNER W HUNSAKER
Title or Position: OWNER/PRESIDENT
Credential: DDS
Phone: 435-760-7903