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NPI Code Detail

MEDICARE: JANELLE HOLDEN TANNER DDS INC

MEDICARE: JANELLE HOLDEN TANNER DDS INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223P0221XPediatric Dentistry41617CA

General Provider Information

NPI Number : 1093250961
Entity Type Code : Organization
Provider Name (Legal Business Name) : JANELLE HOLDEN TANNER DDS INC
Provider Business Mailing Address
First Line : 451 MANHATTAN BEACH BLVD
Second Line : SUITE D226
City : MANHATTAN BEACH
State : CA
Zip : 90266-5345
Country : US
Telephone Number : 310-545-5757
Fax Number : 310-545-2929
Provider Business Practice Location Address
First Line : 451 MANHATTAN BEACH BLVD
Second Line : SUITE D226
City : MANHATTAN BEACH
State : CA
Zip : 90266-5345
Country : US
Telephone Number : 310-545-5757
Fax Number : 310-545-2929
Authorized Official
Title or Position : OFFICE ADMINISTRATOR
Name : ELVA MATA
Credential :
Telephone Number : 310-545-5757
Provider Enumeration Date : 12/30/2016
Last Update Date : 12/30/2016

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