Healthcare Provider Details

I. General information

NPI: 1841092780
Provider Name (Legal Business Name): TANNER DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16201 E INDIANA AVE STE 5450
SPOKANE VALLEY WA
99216-2830
US

IV. Provider business mailing address

522 W RIVERSIDE AVE # 6541
SPOKANE WA
99201-0580
US

V. Phone/Fax

Practice location:
  • Phone: 303-902-5021
  • Fax:
Mailing address:
  • Phone: 720-281-9864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: STEVEN JACOB TANNER
Title or Position: DENTIST
Credential: DDS
Phone: 303-902-5021