Healthcare Provider Details

I. General information

NPI: 1245538693
Provider Name (Legal Business Name): TARA SEXTON DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2011
Last Update Date: 03/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 CYNWYD RD
BALA CYNWYD PA
19004-3345
US

IV. Provider business mailing address

8 CYNWYD RD
BALA CYNWYD PA
19004-3345
US

V. Phone/Fax

Practice location:
  • Phone: 610-664-8466
  • Fax: 610-664-9882
Mailing address:
  • Phone: 610-664-8466
  • Fax: 610-664-9882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS026231-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: