1851136659 NPI number — DR. TANNER ISAAC WAKEFIELD DDS

Table of content: DR. TANNER ISAAC WAKEFIELD DDS (NPI 1851136659)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851136659 NPI number — DR. TANNER ISAAC WAKEFIELD DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WAKEFIELD
Provider First Name:
TANNER
Provider Middle Name:
ISAAC
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851136659
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
34800 BOB WILSON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92134-1098
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-532-6400
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
NAVAL HEALTH CLINIC CHERRY POINT
Provider Second Line Business Practice Location Address:
4389 BEAUFORT RD
Provider Business Practice Location Address City Name:
CHERRY POINT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-466-0400
Provider Business Practice Location Address Fax Number:
252-466-0440
Provider Enumeration Date:
06/25/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DS044720 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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