| Jon D Tanner, Dds, Pc | |
|
1305 21st Ave Suite 102 Fairbanks AK 99701-6084 | |
| (907) 456-5665 | |
| (907) 456-1753 |
| Full Name | Jon D Tanner, Dds, Pc |
|---|---|
| Speciality | Dentist |
| Location | 1305 21st Ave, Fairbanks, Alaska |
| Authorized Official Name and Position | Jon D Tanner (PRESIDENT) |
| Authorized Official Contact | 9074565665 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jon D Tanner, Dds, Pc 1305 21st Ave Suite 102 Fairbanks AK 99701-6084 Ph: (907) 456-5665 | Jon D Tanner, Dds, Pc 1305 21st Ave Suite 102 Fairbanks AK 99701-6084 Ph: (907) 456-5665 |
| NPI Number | 1851634265 |
|---|---|
| Provider Enumeration Date | 04/03/2013 |
| Last Update Date | 04/03/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851634265 | NPI | - | NPPES |
| DD9416 | Medicaid | AK | |
| 834977 | Other | AK | UNITED CONCORDIA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D 868 (Alaska) | Primary |
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