Healthcare Provider Details

I. General information

NPI: 1568988103
Provider Name (Legal Business Name): TAMARA RENEE CUNHA DENTAL ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2017
Last Update Date: 08/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BEE ST
CHARLESTON SC
29401-5703
US

IV. Provider business mailing address

430 ALLIED PL APT 1425
GAITHERSBURG MD
20877-3185
US

V. Phone/Fax

Practice location:
  • Phone: 843-557-5011
  • Fax:
Mailing address:
  • Phone: 603-860-9994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: