1437607413 NPI number — DR. KENT TANNER WASHINGTON D.D.S.

Table of content: DR. KENT TANNER WASHINGTON D.D.S. (NPI 1437607413)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437607413 NPI number — DR. KENT TANNER WASHINGTON D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WASHINGTON
Provider First Name:
KENT
Provider Middle Name:
TANNER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
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:
1437607413
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 MALLET HILL RD
Provider Second Line Business Mailing Address:
APT D1
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29223-5726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-699-9989
Provider Business Mailing Address Fax Number:
803-699-8035

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
625 CONSTITUTION DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUMTER
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29154-8190
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-699-9989
Provider Business Practice Location Address Fax Number:
803-699-8035
Provider Enumeration Date:
09/19/2016

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: 1223X0400X , with the licence number:  8136 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com