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General NPI Number Information
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NPI Number | 1689418212
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Entity Type | Individual
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Provider Name | TANNER MILES ANGLIN
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Gender | Male
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Dates
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Enumeration Date | 06/19/2024
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Last Update Date | 06/19/2024
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Provider Practice Location Address
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Address Line | 908 HWY 37 S
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City | MT VERNON
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State | TX
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Zip | 75457-4500
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Country | US
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Telephone | 903-588-3384
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Fax |
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Provider Business Mailing Address
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Address Line | 2099 VISTA RIDGE RD
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City | MELISSA
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State | TX
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Zip | 75454-9716
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Country | US
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Telephone | 972-741-3132
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 40422
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License Number State | TX
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