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General NPI Number Information
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NPI Number | 1851634265
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Entity Type | Organization
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Legal Business Name | JON D TANNER, DDS, PC
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Dates
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Enumeration Date | 04/03/2013
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Last Update Date | 04/03/2013
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Provider Practice Location Address
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Address Line | 1305 21ST AVE SUITE 102
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City | FAIRBANKS
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State | AK
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Zip | 99701-6084
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Country | US
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Telephone | 907-456-5665
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Fax | 907-456-1753
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Provider Business Mailing Address
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Address Line | 1305 21ST AVE SUITE 102
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City | FAIRBANKS
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State | AK
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Zip | 99701-6084
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Country | US
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Telephone | 907-456-5665
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Fax | 907-456-1753
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Authorized Official
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Title or Position | PRESIDENT
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Name | JON D TANNER
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Credential | DDS
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Telephone | 907-456-5665
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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 | D 868
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License Number State | AK
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