Individual
TANNER COLE GODFREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
736 S 2000 W STE 2, SYRACUSE, UT 84075-9692
(801) 614-9090
Mailing address
3000 LISA LN, FULTONDALE, AL 35068-1025
(435) 760-3457
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
12890244-9922
UT
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
2571247
ID
Other
Enumeration date
06/08/2022
Last updated
03/05/2025
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