Organization
BENJAMIN F. TANNER II DMD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LANDON K GRANTHAM (OFFICE MANAGER)
(912) 487-5271
Entity
Organization
Contact information
Practice address
114 HUXFORD ST, HOMERVILLE, GA 31634-2357
(912) 487-5271
(912) 487-5271
Mailing address
114 HUXFORD ST, HOMERVILLE, GA 31634-2357
(912) 487-5271
(912) 487-5271
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN013182
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
827915201D
—
GA
Enumeration date
04/19/2010
Last updated
04/19/2010
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