Provider Demographics
NPI:1346832789
Name:KONKLE & TANNER DENTAL CARE, LLC
Entity Type:Organization
Organization Name:KONKLE & TANNER DENTAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOUSTON
Authorized Official - Middle Name:R
Authorized Official - Last Name:TANNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-838-3073
Mailing Address - Street 1:7350 S MCCLINTOCK DR
Mailing Address - Street 2:STE 103
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-5006
Mailing Address - Country:US
Mailing Address - Phone:480-838-3073
Mailing Address - Fax:480-838-5504
Practice Address - Street 1:7350 S MCCLINTOCK DR
Practice Address - Street 2:STE 103
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-5006
Practice Address - Country:US
Practice Address - Phone:480-838-3073
Practice Address - Fax:480-838-5504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty