Provider Demographics
NPI:1497076715
Name:TANNER, SHAUNA (DDS)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
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 1:9298 POSITANO LN
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-7393
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:303 BANCARIO
Practice Address - Street 2:STE #11-12
Practice Address - City:MARION
Practice Address - State:AR
Practice Address - Zip Code:72364-2825
Practice Address - Country:US
Practice Address - Phone:870-739-2992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9156122300000X
AR39511223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0221XDental ProvidersDentistPediatric Dentistry