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General NPI Number Information
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NPI Number | 1508234766
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Entity Type | Organization
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Legal Business Name | DAVID A TANNER DDS INC
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Dates
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Enumeration Date | 09/04/2015
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Last Update Date | 09/04/2015
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Provider Practice Location Address
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Address Line | 22800 LYONS AVE STE 200
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City | NEWHALL
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State | CA
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Zip | 91321-2898
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Country | US
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Telephone | 661-254-1884
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Fax |
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Provider Business Mailing Address
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Address Line | 22800 LYONS AVE STE 200
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City | NEWHALL
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State | CA
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Zip | 91321-2898
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Country | US
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Telephone | 661-254-1884
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID TANNER
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Credential | DDS
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Telephone | 66122541884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 30463
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License Number State | CA
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