=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396586319
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAMARA KAPETANOVIC DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2024
-----------------------------------------------------
Last Update Date | 06/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14422 ORCHARD PKWY # 200
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80023-9272
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-452-0811
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1890 MILLSTONE CT
-----------------------------------------------------
City | ALPHARETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30004-7424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-512-5258
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 00205964
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------