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General NPI Number Information
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NPI Number | 1366607236
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Entity Type | Individual
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Provider Name | TAMARA O MCCALLUM D.D.S
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Gender | Female
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Dates
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Enumeration Date | 07/21/2008
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Last Update Date | 07/21/2008
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Provider Practice Location Address
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Address Line | 2960 AVENTURA BLVD
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City | AVENTURA
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State | FL
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Zip | 33180-3103
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Country | US
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Telephone | 305-935-1400
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Fax |
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Provider Business Mailing Address
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Address Line | 8517 NW 196TH TER
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City | HIALEAH
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State | FL
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Zip | 33015-6920
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Country | US
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Telephone | 301-442-4816
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN 18474
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License Number State | FL
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