Search › South Carolina › 1223G0001X
Tanner Gustafson
NPI 1669049821 · on the registry since 2021 · sole proprietor
Practice
- Address
- 27a Kemmerlin Ln
Beaufort, SC 29907 - Phone
- (843) 522-2007
- Organisation at this address
- Beaufort Smiles Pa
Inferred from a shared address, not stated in the registry.
Registry record
- Primary taxonomy
- 1223G0001X
1223G0001X
- Also registered as
- 122300000X
- Licence states on file
- GA, SC
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2023-05-03
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in South Carolina