Provider Demographics
NPI:1073169504
Name:TANNER SEAGO, DMD, LLC
Entity Type:Organization
Organization Name:TANNER SEAGO, DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TANNER
Authorized Official - Middle Name:A
Authorized Official - Last Name:SEAGO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:614-315-0160
Mailing Address - Street 1:1 TIBER WAY
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-2911
Mailing Address - Country:US
Mailing Address - Phone:614-315-0160
Mailing Address - Fax:
Practice Address - Street 1:1613 KINNEYS LN
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-3115
Practice Address - Country:US
Practice Address - Phone:614-315-0160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental