MEDICARE: DR. TANNER MARTIN DMD

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
1	122300000X	Dentist	DS045257	PA

General Provider Information

NPI Number	:	1134019763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TANNER MARTIN DMD

Provider Business Mailing Address
First Line	:	62 W COLUMBUS AVE
Second Line	:
City	:	CORRY
State	:	PA
Zip	:	16407-1136
Country	:	US
Telephone Number	:	814-665-3621
Fax Number	:	814-664-4117

Provider Business Practice Location Address
First Line	:	62 W COLUMBUS AVE
Second Line	:
City	:	CORRY
State	:	PA
Zip	:	16407-1136
Country	:	US
Telephone Number	:	814-665-3621
Fax Number	:	814-664-4117

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2025
Last Update Date	:	07/07/2025

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Directions to “ DR. TANNER MARTIN DMD” Practice Location

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