Provider Demographics
NPI:1043033293
Name:TANNER MITCHELL DDS LLC
Entity type:Organization
Organization Name:TANNER MITCHELL DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TANNER
Authorized Official - Middle Name:JAMESON
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-656-0709
Mailing Address - Street 1:219 LORI ANN DR
Mailing Address - Street 2:
Mailing Address - City:WHITELAND
Mailing Address - State:IN
Mailing Address - Zip Code:46184-1677
Mailing Address - Country:US
Mailing Address - Phone:317-656-0709
Mailing Address - Fax:
Practice Address - Street 1:3105 MIDDLE RD STE A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-4472
Practice Address - Country:US
Practice Address - Phone:812-379-4321
Practice Address - Fax:812-379-1977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty