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General NPI Number Information
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NPI Number | 1790904217
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Entity Type | Individual
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Provider Name | PATRICK MCNEIL TANNER DMD
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Gender | Male
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5856 HARRISON BLVD STE B
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City | SOUTH OGDEN
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State | UT
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Zip | 84403-4397
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Country | US
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Telephone | 801-475-7776
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Fax |
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Provider Business Mailing Address
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Address Line | 5856 HARRISON BLVD STE B
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City | SOUTH OGDEN
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State | UT
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Zip | 84403-4397
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Country | US
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Telephone | 801-475-7776
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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 | 6001081
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License Number State | UT
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