David A Tanner, DDS – General Practice Dentistry

Key facts

NPI: 1043435936
Entity type: Individual (NPI type 1)
Primary specialty: General Practice Dentistry 1223G0001X
License: 30463 (CA)
Practice address: 22800 Lyons Ave
Suite 200
Newhall, CA 91321
Phone: (661) 254-1884
Fax: (661) 254-3655
NPI assigned: Apr 16, 2007
Sex: Male
Sole proprietor: No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

David a Tanner DDS Inc General Practice Dentistry · Newhall, CA · NPI 1508234766

NPD (past) Authorized official GENERAL PRACTICE
S Kutlay DDS Corp Dental Clinic/Center · Santa Clarita, CA · NPI 1437630340

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
30463	CA	MD	Speech-Language Pathologist

Practice roles

Organization	Specialty	Status	New patients
David a Tanner DDS Inc	General Practice	Past since Jun 24, 2002	Accepting new patients
S Kutlay DDS Corp		Past since Aug 8, 2018	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
General Practice Dentistry	1223G0001X	30463	CA	Yes

Addresses

Primary practice location

22800 Lyons Ave
Suite 200
Newhall, CA 91321

Mailing address

22800 Lyons Ave
Suite 200
Newhall, CA 91321
Phone (661) 254-1884

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1043435936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22800 LYONS AVE",
            "address_2": "SUITE 200",
            "city": "NEWHALL",
            "state": "CA",
            "postal_code": "91321",
            "telephone_number": "661-254-1884",
            "fax_number": "661-254-3655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22800 LYONS AVE",
            "address_2": "SUITE 200",
            "city": "NEWHALL",
            "state": "CA",
            "postal_code": "91321",
            "telephone_number": "661-254-1884",
            "fax_number": "661-254-3655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANNER",
        "first_name": "DAVID",
        "middle_name": "A",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "30463",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newhall, CA

All providers in Newhall, CA · General Practice Dentistry in California

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.