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General NPI Number Information
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NPI Number | 1265874663
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Entity Type | Individual
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Provider Name | TAMARA LARUE R.D.H.
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Gender | Female
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Dates
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Enumeration Date | 07/25/2013
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Last Update Date | 07/25/2013
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Provider Practice Location Address
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Address Line | 222 RICHMOND AVE 130B
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City | BATAVIA
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State | NY
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Zip | 14020-1227
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Country | US
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Telephone | 585-297-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 48 DOMEDION AVE LOWER
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City | BUFFALO
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State | NY
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Zip | 14211-2109
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Country | US
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Telephone | 716-533-0393
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 024890
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License Number State | NY
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