Provider Demographics
NPI:1437833209
Name:STORBECK, TANNER (DDS)
Entity type:Individual
Prefix:DR
First Name:TANNER
Middle Name:
Last Name:STORBECK
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:PO BOX 229
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:IA
Mailing Address - Zip Code:50482-0229
Mailing Address - Country:US
Mailing Address - Phone:641-425-0624
Mailing Address - Fax:
Practice Address - Street 1:5541 NW 86TH ST
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-1702
Practice Address - Country:US
Practice Address - Phone:515-276-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-10110122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist