Healthcare Provider Details

I. General information

NPI: 1508027285
Provider Name (Legal Business Name): JULIETTE TAMKIN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 04/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 LOMBARD ST.
THOUSAND OAKS CA
91360
US

IV. Provider business mailing address

5737 KANAN ROAD #524
AGOURA HILLS CA
91301
US

V. Phone/Fax

Practice location:
  • Phone: 805-495-2431
  • Fax: 805-497-7272
Mailing address:
  • Phone: 818-259-6416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number55799
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number55799
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: