1588674642 NPI number — DR. JOHN P TANNER DDS MD

Table of content: DR. JOHN P TANNER DDS MD (NPI 1588674642)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588674642 NPI number — DR. JOHN P TANNER DDS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TANNER
Provider First Name:
JOHN
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588674642
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 802752
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64180-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-561-1115
Provider Business Mailing Address Fax Number:
816-753-4493

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4700 BELLEVIEW
Provider Second Line Business Practice Location Address:
STE L 10
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64112-1360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-561-1115
Provider Business Practice Location Address Fax Number:
816-931-7912
Provider Enumeration Date:
08/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  DEO15216-DENTAL , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 16670147 . This is a "BCBS OF KCMO" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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