Provider Demographics
NPI:1891688487
Name:HARTVIGSEN, TANNER BRADLEY (DMD)
Entity type:Individual
Prefix:
First Name:TANNER
Middle Name:BRADLEY
Last Name:HARTVIGSEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13761 N LITCHFIELD RD STE 103
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-4272
Mailing Address - Country:US
Mailing Address - Phone:623-975-3933
Mailing Address - Fax:
Practice Address - Street 1:13761 N LITCHFIELD RD STE 103
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-4272
Practice Address - Country:US
Practice Address - Phone:623-975-3933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0124961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice