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General NPI Number Information
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NPI Number | 1669101200
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Entity Type | Individual
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Provider Name | TANNER COLE GODFREY DMD
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Gender | Male
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Dates
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Enumeration Date | 06/08/2022
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 736 S 2000 W STE 2
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City | SYRACUSE
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State | UT
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Zip | 84075-9692
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Country | US
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Telephone | 801-614-9090
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Fax |
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Provider Business Mailing Address
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Address Line | 3000 LISA LN
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City | FULTONDALE
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State | AL
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Zip | 35068-1025
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Country | US
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Telephone | 435-760-3457
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Fax |
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 2571247
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 12890244-9922
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License Number State | UT
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