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General NPI Number Information
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NPI Number | 1588674642
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Entity Type | Individual
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Provider Name | JOHN P TANNER DDS MD
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Gender | Male
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4700 BELLEVIEW STE L 10
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City | KANSAS CITY
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State | MO
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Zip | 64112-1360
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Country | US
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Telephone | 816-561-1115
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Fax | 816-931-7912
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Provider Business Mailing Address
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Address Line | PO BOX 802752
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City | KANSAS CITY
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State | MO
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Zip | 64180-0001
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Country | US
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Telephone | 816-561-1115
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Fax | 816-753-4493
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DEO15216-DENTAL
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License Number State | MO
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