Tyson Tanner, DMD
Individual provider Active NPI General Practice Dentistry · Chariton, IA
NPI 1124406665 · NPPES record last updated Dec 9, 2020
Key facts
- NPI
- 1124406665
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 9377 (IA)
- Practice address
- 117 N Main St
Chariton, IA 50049-1272 - Phone
- (641) 774-2312
- NPI assigned
- May 18, 2015
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150722005356 | IA | Order and Referring Only - Oral Surgery |
8123331998 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9377 | IA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Richard a Rips DDS | General Practice | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 9377 | IA | Yes |
Addresses
Primary practice location
117 N Main St
Chariton, IA 50049-1272
Mailing address
117 N Main St
Chariton, IA 50049-1272
Phone (641) 774-2312
Other providers in Chariton, IA
- Spencer Foot and Ankle Clinic Inc
- Cameron Ryan Storm
- Rodney R Stream
- Philip Dewain Sundquist
- Surgical Clinic of Southern Iowa, PC
- Kandy Thomas
- Kayla June Wallace
- Audrey Marie Wheeler
All providers in Chariton, IA · General Practice Dentistry in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 9, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.