Healthcare Provider Details

I. General information

NPI: 1376039404
Provider Name (Legal Business Name): TAMERA MARIE MERRIWETHER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2018
Last Update Date: 07/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DENTAL CLINI- GRAFENWOEHR BUILDING 475
GRAFENWOEHR BAVARIA
92655
DE

IV. Provider business mailing address

4615 LOWELL DR APT 1803
NORTH CHARLESTON SC
29418-3127
US

V. Phone/Fax

Practice location:
  • Phone: 964-183-1720
  • Fax:
Mailing address:
  • Phone: 843-513-7992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number11139
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: