Provider Demographics
NPI:1588674642
Name:TANNER, JOHN P (DDS MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:TANNER
Suffix:
Gender:M
Credentials:DDS MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 802752
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-0001
Mailing Address - Country:US
Mailing Address - Phone:816-561-1115
Mailing Address - Fax:816-753-4493
Practice Address - Street 1:4700 BELLEVIEW
Practice Address - Street 2:STE L 10
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-1360
Practice Address - Country:US
Practice Address - Phone:816-561-1115
Practice Address - Fax:816-931-7912
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODEO15216-DENTAL1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO16670147OtherBCBS OF KCMO
MOK521887Medicare ID - Type Unspecified
E04155Medicare UPIN