MEDICARE: TANNER DAHL 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	DE60967449	WA
2	1223G0001X	General Practice Dentistry	DE60967449	WA
3	1223P0221X	Pediatric Dentistry	D012788	AZ

General Provider Information

NPI Number	:	1700438793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANNER DAHL DMD

Provider Business Mailing Address
First Line	:	4888 N STONE AVE UNIT 120
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-5749
Country	:	US
Telephone Number	:	520-670-3909
Fax Number	:

Provider Business Practice Location Address
First Line	:	4888 N STONE AVE UNIT 120
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-5749
Country	:	US
Telephone Number	:	520-670-3909
Fax Number	:

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

Provider Enumeration Date	:	07/10/2019
Last Update Date	:	05/19/2026

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