Provider Demographics
NPI:1619284031
Name:TANNER, ELIZABETH LEIGH (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:LEIGH
Last Name:TANNER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 WESTGATE PKWY
Mailing Address - Street 2:#203
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-3808
Mailing Address - Country:US
Mailing Address - Phone:828-747-1558
Mailing Address - Fax:828-747-1558
Practice Address - Street 1:408 DEPOT ST
Practice Address - Street 2:SUITE 120
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4313
Practice Address - Country:US
Practice Address - Phone:828-747-1558
Practice Address - Fax:828-747-1558
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC98941223G0001X
TN92011223G0001X
MADN18557641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice