Healthcare Provider Details

I. General information

NPI: 1851612840
Provider Name (Legal Business Name): TAMMY CAIRNS R.D.H., B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 12/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2192 WILLOW ST
CRAIG CO
81625-3745
US

IV. Provider business mailing address

3412 CANTERBURY LN
PUEBLO CO
81005-3335
US

V. Phone/Fax

Practice location:
  • Phone: 719-963-5778
  • Fax:
Mailing address:
  • Phone: 719-963-5778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH-905306
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: