Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 5855 | NC |
NPI | 1023022076 |
---|---|
Provider Name | Dr. James H. Tanner |
First Address | Greensboro, NC 27408-2015 |
Second Address | Greensboro, NC 27408-2015 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 08/07/2007 |