Organization
CLELEN C. TANNER, DDS, INC
Active
Other names
Foothill Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLELEN C. TANNER DDS (OWNER)
(510) 733-1455
Entity
Organization
Contact information
Practice address
21911 FOOTHILL BLVD, HAYWARD, CA 94541-2118
(510) 733-1455
(510) 889-8395
Mailing address
21911 FOOTHILL BLVD, HAYWARD, CA 94541-2118
(510) 733-1455
(510) 889-8395
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
26003
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1215080445
NPI
CA
Enumeration date
04/28/2010
Last updated
04/28/2010
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