Individual
DR. DANIEL LEE TANNEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
224 W D.L. INGRAM AVENUE, BLDG. 1408, CANNON AFB, NM 88103
(575) 784-4041
Mailing address
224 W D.L. INGRAM AVENUE, BLDG. 1408, CANNON AFB, NM 88103
(575) 784-4041
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
13427199-9926
UT
122300000X
Dentist
37309
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1543552158
DOD
—
Enumeration date
07/27/2021
Last updated
08/06/2024
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