Tanner Brunnworth, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DN24128 Issued in FL

Practice address

101 4TH Ave Ste D
Crestview, FL 32539-2401

Phone

(850) 683-3544

NPI assigned

May 19, 2019

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1558224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691280000000",
    "number": "1508422197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 4TH AVE STE D",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325392401",
            "telephone_number": "850-683-3544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 4TH AVE STE D",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325392401",
            "telephone_number": "850-683-3544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUNNWORTH",
        "first_name": "TANNER",
        "name_prefix": "Mr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-05-19",
        "last_updated": "2023-08-06",
        "certification_date": "2023-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN24128",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melanie Broome, PT, CEEAA, VESTIB
• Judith M Brown, LMT
• Katherine Brown
• Kimberly Edwina Brown, PTA
• Troy Brown III, D.M.D.
• Justin Buchanan, D.M.D.
• Carla J Bulla, PT, DPT
• Ryan Bullard, LCSW, BCD, PMH-C
• Kathryn Anne Burchfield, DMD
• Shelbi Burgett

• Dentist in Crestview, FL
• Providers in Crestview, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.