Provider Demographics
NPI:1023022076
Name:TANNER, JAMES H (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:H
Last Name:TANNER
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 BENJAMIN PKWY
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-2015
Mailing Address - Country:US
Mailing Address - Phone:336-545-9084
Mailing Address - Fax:336-545-5679
Practice Address - Street 1:1602 BENJAMIN PKWY
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-2015
Practice Address - Country:US
Practice Address - Phone:336-545-9084
Practice Address - Fax:336-545-5679
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC58551223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics