Jonathan Tankersley, DDS

Individual provider Active NPI General Practice Dentistry · Hanscom Afb, MA

NPI 1194255166 · NPPES record last updated Dec 1, 2025

Key facts

NPI
1194255166
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Dentistry 1223G0001X
License
32977 (TX)
Practice address
90 Vandenberg Dr
Hanscom Afb, MA 01731-2104
Phone
(781) 225-6324
NPI assigned
Jun 13, 2017
Sex
Male
Sole proprietor
Yes

Medicare participation

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

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
32977TXMDPsychologist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 32977 TX Yes

Addresses

Primary practice location

90 Vandenberg Dr
Hanscom Afb, MA 01731-2104

Mailing address

90 Vandenberg Dr
Hanscom Afb, MA 01731-2104
Phone (781) 225-6324

Other providers in Hanscom Afb, MA

All providers in Hanscom Afb, MA · General Practice Dentistry in Massachusetts

Sources for this page

Verify at the official NPI Registry.