MEDICARE: DR. ELIZABETH LEIGH TANNER D.M.D.

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	1223G0001X	General Practice Dentistry	9894	NC
2	1223G0001X	General Practice Dentistry	9201	TN
3	1223G0001X	General Practice Dentistry	DN1855764	MA

General Provider Information

NPI Number	:	1619284031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH LEIGH TANNER D.M.D.

Provider Business Mailing Address
First Line	:	30 WESTGATE PKWY
Second Line	:	#203
City	:	ASHEVILLE
State	:	NC
Zip	:	28806-3808
Country	:	US
Telephone Number	:	828-747-1558
Fax Number	:	828-747-1558

Provider Business Practice Location Address
First Line	:	408 DEPOT ST
Second Line	:	SUITE 120
City	:	ASHEVILLE
State	:	NC
Zip	:	28801-4313
Country	:	US
Telephone Number	:	828-747-1558
Fax Number	:	828-747-1558

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

Provider Enumeration Date	:	09/07/2010
Last Update Date	:	12/08/2015

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