Individual
DR. NATHAN JOHN TANNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
200 E BROADWAY AVE # 1190, JACKSON, WY 83001-8634
(307) 733-5222
Mailing address
PO BOX 1190, JACKSON, WY 83001-1190
(307) 733-2555
(307) 733-2552
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D7768
OR
1223G0001X
General Practice Dentistry
1538
WY
1223G0001X
General Practice Dentistry
4200
MT
1223G0001X
General Practice Dentistry
Primary
WY1538
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
154182000
—
WY
Enumeration date
02/15/2007
Last updated
06/03/2021
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