Healthcare Provider Details

I. General information

NPI: 1609366236
Provider Name (Legal Business Name): TAMMY WARNER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2018
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 N SEE VEE LN
BISHOP CA
93514-8130
US

IV. Provider business mailing address

645 HOUSTON DR
BISHOP CA
93514-7650
US

V. Phone/Fax

Practice location:
  • Phone: 760-873-3443
  • Fax: 760-873-3889
Mailing address:
  • Phone: 760-937-3254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number3319
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number850
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number13942
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH010320
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: