Provider Demographics
NPI:1942270210
Name:TANNER, STEPHEN JAY (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JAY
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:USA DENTAC LANDSTUHL
Mailing Address - Street 2:CMR 402
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09180
Mailing Address - Country:US
Mailing Address - Phone:314-590-4308
Mailing Address - Fax:
Practice Address - Street 1:HW, LANDSTUHL DENTAL ACTIVITY
Practice Address - Street 2:GEB 3703, RM 205
Practice Address - City:LANDSTUHL
Practice Address - State:LANDSTUHL
Practice Address - Zip Code:66849
Practice Address - Country:DE
Practice Address - Phone:314-590-4308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA417941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice