=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417784315
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TAMARA SARDAR DDS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2024
-----------------------------------------------------
Last Update Date | 12/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 AVE A #A
-----------------------------------------------------
City | SNOHOMISH
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98290-2961
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-863-2517
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 AVE A #A
-----------------------------------------------------
City | SNOHOMISH
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98290-2961
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-863-2517
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PROVIDER
-----------------------------------------------------
Name | TAMARA SARDAR AL KARADAGHI
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 360-389-4784
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223X2210X
-----------------------------------------------------
Taxonomy Name | Orofacial Pain Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------