Healthcare Provider Details

I. General information

NPI: 1972504710
Provider Name (Legal Business Name): TAMARA KAY ABBETT D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 02/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 ELLENDALE DR
MEDFORD OR
97504-8216
US

IV. Provider business mailing address

940 ELLENDALE DR
MEDFORD OR
97504-8216
US

V. Phone/Fax

Practice location:
  • Phone: 541-779-9059
  • Fax: 541-779-0226
Mailing address:
  • Phone: 541-779-9059
  • Fax: 541-779-0226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD6842
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: