Active NPI
Jeffrey Michael Tanner, D.D.S.
- Dentist
- Santa Monica, CA
National Provider Identifier
1124265814
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 57780
- Practice address
- 1531 6TH St Apt 202
Santa Monica, CA 90401-2535 - Phone
- (816) 651-5000
- NPI assigned
- Jan 16, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 57780 | CA | Primary |
Addresses
Primary practice location
1531 6TH St Apt 202
Santa Monica, CA 90401-2535
Mailing address
1531 6TH St Apt 202
Santa Monica, CA 90401-2535
Phone (816) 651-5000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jul 5, 2018 through Jul 5, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 57780 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1232064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1232064000000",
"number": "1124265814",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1531 6TH ST APT 202",
"city": "SANTA MONICA",
"state": "CA",
"postal_code": "904012535",
"telephone_number": "816-651-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1531 6TH ST APT 202",
"city": "SANTA MONICA",
"state": "CA",
"postal_code": "904012535",
"telephone_number": "816-651-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TANNER",
"first_name": "JEFFREY",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-01-16",
"last_updated": "2009-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "57780",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Monica, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.