Healthcare Provider Details

I. General information

NPI: 1437872777
Provider Name (Legal Business Name): TAM & COTTRELL DENTAL PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2022
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 E BETTERAVIA RD STE C
SANTA MARIA CA
93454-8851
US

IV. Provider business mailing address

570 E BETTERAVIA RD STE C
SANTA MARIA CA
93454-8851
US

V. Phone/Fax

Practice location:
  • Phone: 805-922-2888
  • Fax:
Mailing address:
  • Phone: 805-922-2888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. KEITH TAM
Title or Position: GENERAL PARTNER
Credential: DDS
Phone: 949-322-9778