Tanner Gustafson

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

10270 Issued in SC

Practice address

27A Kemmerlin LN
Beaufort, SC 29907-2702

Phone

(843) 522-2007

NPI assigned

Jun 7, 2021

Last updated

May 3, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Jebediah S Christy DDS - Pooler PLLC

  dba Aspen Dental

  • Dental Clinic/Center
  • Pooler, GA
  • NPI 1043617293
  NPD (past)

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

{
    "created_epoch": "1623024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683072000000",
    "number": "1669049821",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1137 SALEM BAY DR",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299025252",
            "telephone_number": "320-815-1163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27A KEMMERLIN LN",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299072702",
            "telephone_number": "843-522-2007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "TANNER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-06-07",
        "last_updated": "2023-05-03",
        "certification_date": "2023-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN122359",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "10270",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tgustafson17@hotmail.com",
            "affiliation": "N",
            "endpointDescription": "Email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "27A Kemmerlin Ln",
            "city": "Beaufort",
            "state": "SC",
            "country_code": "US",
            "postal_code": "299072702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Christine Gross, M.D., PH.D.
• Thomas D Grubbs, DDS
• Ashley S. Gruber, LPC, NCC
• Gullah Medical Equipment and Supplies
• Timothy John Gurley, PTA
• H Lucius Laffitte Jr MD LLC
• Allison Marie Haase
• Marianne M Hagood, APRN
• Diane Elizabeth Haigler, P.T.
• Bruce Kenneth Hall, DMD MAGD

• General Practice Dentistry in Beaufort, SC
• Providers in Beaufort, SC by specialty
• General Practice Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 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.