Provider Demographics
NPI:1528743804
Name:TEMPLIN, TANNER JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:TANNER
Middle Name:JAMES
Last Name:TEMPLIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3617 DENMARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-7756
Mailing Address - Country:US
Mailing Address - Phone:712-326-3205
Mailing Address - Fax:
Practice Address - Street 1:3617 DENMARK DR STE 100
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-7756
Practice Address - Country:US
Practice Address - Phone:712-326-3205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE79351223G0001X
IADDS-101031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice