Provider Demographics
NPI:1710727888
Name:RESSEGUIE, TANNER MARCUS (DDS)
Entity type:Individual
Prefix:
First Name:TANNER
Middle Name:MARCUS
Last Name:RESSEGUIE
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 1:850 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:MO
Mailing Address - Zip Code:64601-3673
Mailing Address - Country:US
Mailing Address - Phone:660-646-3802
Mailing Address - Fax:
Practice Address - Street 1:500 S DAVIS ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MO
Practice Address - Zip Code:64644-1434
Practice Address - Country:US
Practice Address - Phone:816-465-6031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20240175481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice