Provider Demographics
NPI:1437269693
Name:TANNER, WENDY A (DDS)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:A
Last Name:TANNER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:OSSEO
Mailing Address - State:MN
Mailing Address - Zip Code:55369-1241
Mailing Address - Country:US
Mailing Address - Phone:763-425-2626
Mailing Address - Fax:
Practice Address - Street 1:30 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:OSSEO
Practice Address - State:MN
Practice Address - Zip Code:55369-1241
Practice Address - Country:US
Practice Address - Phone:763-425-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice