Individual
TANNER GUSTAFSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
27A KEMMERLIN LN, BEAUFORT, SC 29907-2702
(843) 522-2007
Mailing address
1137 SALEM BAY DR, BEAUFORT, SC 29902-5252
(320) 815-1163
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DN122359
GA
1223G0001X
General Practice Dentistry
Primary
10270
SC
Other
Enumeration date
06/07/2021
Last updated
05/03/2023
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