Provider Demographics
NPI:1114184439
Name:WILLIAMS AND TANNER, D.M.D., P.A.
Entity type:Organization
Organization Name:WILLIAMS AND TANNER, D.M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STAFFORD
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:TANNER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-884-5166
Mailing Address - Street 1:1065 JOHNNIE DODDS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-6153
Mailing Address - Country:US
Mailing Address - Phone:843-884-5166
Mailing Address - Fax:
Practice Address - Street 1:1065 JOHNNIE DODDS BLVD STE A
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-6153
Practice Address - Country:US
Practice Address - Phone:843-884-5166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty