Organization
JON D TANNER, DDS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JON D TANNER DDS (PRESIDENT)
(907) 456-5665
Entity
Organization
Contact information
Practice address
1305 21ST AVE, SUITE 102, FAIRBANKS, AK 99701-6084
(907) 456-5665
(907) 456-1753
Mailing address
1305 21ST AVE, SUITE 102, FAIRBANKS, AK 99701-6084
(907) 456-5665
(907) 456-1753
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D 868
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
834977
UNITED CONCORDIA
AK
05
—
DD9416
—
AK
Enumeration date
04/03/2013
Last updated
04/03/2013
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