Healthcare Provider Details

I. General information

NPI: 1821185497
Provider Name (Legal Business Name): TAMANA DOLLICIA BEGAY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 05/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 INTERNATIONAL BLVD. DENTAL DEPT
OAKLAND CA
94601
US

IV. Provider business mailing address

6724 AVENAL AVE
OAKLAND CA
94605-2344
US

V. Phone/Fax

Practice location:
  • Phone: 510-535-4450
  • Fax: 510-535-4494
Mailing address:
  • Phone: 503-412-9892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number53759
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: