Provider Demographics
NPI:1275186231
Name:TANNER AND MONAGHAN, PLLC
Entity Type:Organization
Organization Name:TANNER AND MONAGHAN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:EUGENIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:MONAGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:336-545-9084
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-18
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1184076085OtherNPI
NC1023022076OtherNPI