Individual
JONATHAN COREY TANNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1344 22ND ST S, ST PETERSBURG, FL 33712-2744
(727) 824-8181
Mailing address
7017 MONARCH PARK DR, APOLLO BEACH, FL 33572-8113
(614) 961-9015
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN24535
FL
Other
Enumeration date
11/14/2019
Last updated
11/14/2019
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