Provider Demographics
NPI:1821526740
Name:TANNER, HOUSTON RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:HOUSTON
Middle Name:RICHARD
Last Name:TANNER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:638 PRAIRIE LN
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-9107
Mailing Address - Country:US
Mailing Address - Phone:208-570-7118
Mailing Address - Fax:
Practice Address - Street 1:1920 S OHIO ST
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-6643
Practice Address - Country:US
Practice Address - Phone:785-825-7197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS613701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice