Provider Demographics
NPI:1679001093
Name:TANNER HUNSAKER DDS, PLLC
Entity Type:Organization
Organization Name:TANNER HUNSAKER DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TANNER
Authorized Official - Middle Name:W
Authorized Official - Last Name:HUNSAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:435-760-7903
Mailing Address - Street 1:290 N 200 E
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-4488
Mailing Address - Country:US
Mailing Address - Phone:435-760-7903
Mailing Address - Fax:
Practice Address - Street 1:290 N 200 E
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-4488
Practice Address - Country:US
Practice Address - Phone:435-760-7903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental