Healthcare Provider Details

I. General information

NPI: 1164589834
Provider Name (Legal Business Name): LOREN ASHLEY TARR D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 LINCOLN AVE UNIT 91806
PASADENA CA
91109-5674
US

IV. Provider business mailing address

600 LINCOLN AVE UNIT 91806
PASADENA CA
91109-5674
US

V. Phone/Fax

Practice location:
  • Phone: 206-850-1582
  • Fax:
Mailing address:
  • Phone: 206-850-1582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number9030
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number110878
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: