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General NPI Number Information
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NPI Number | 1710727888
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Entity Type | Individual
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Provider Name | TANNER MARCUS RESSEGUIE DDS
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Gender | Male
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Dates
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Enumeration Date | 05/28/2024
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Last Update Date | 05/28/2024
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Provider Practice Location Address
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Address Line | 500 S DAVIS ST
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City | HAMILTON
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State | MO
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Zip | 64644-1434
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Country | US
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Telephone | 816-465-6031
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Fax |
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Provider Business Mailing Address
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Address Line | 850 FAIRWAY DR
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City | CHILLICOTHEE
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State | MO
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Zip | 64601-3673
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Country | US
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Telephone | 660-646-3802
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2024017548
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License Number State | MO
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