Provider Demographics
NPI:1255773305
Name:TANNER, ROBERT E (DDS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
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 1:22516 SE 64TH PL
Mailing Address - Street 2:STE 120
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5379
Mailing Address - Country:US
Mailing Address - Phone:425-392-8882
Mailing Address - Fax:425-392-9101
Practice Address - Street 1:22516 SE 64TH PL
Practice Address - Street 2:STE 120
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5379
Practice Address - Country:US
Practice Address - Phone:425-392-8882
Practice Address - Fax:425-392-9101
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6439122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist