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General NPI Number Information
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NPI Number | 1053099556
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Entity Type | Individual
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Provider Name | TAMARA FARIS
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Gender | Female
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Dates
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Enumeration Date | 07/06/2023
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Last Update Date | 07/06/2023
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Provider Practice Location Address
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Address Line | 5307 W 79TH ST
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City | BURBANK
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State | IL
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Zip | 60459-1403
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Country | US
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Telephone | 708-424-5650
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Fax |
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Provider Business Mailing Address
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Address Line | 18W070 ROYCE BLVD APT 254
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City | OAKBROOK TERRACE
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State | IL
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Zip | 60181-4888
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Country | US
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Telephone | 414-334-4063
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019034482
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License Number State | IL
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