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General NPI Number Information
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NPI Number | 1689125122
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Entity Type | Individual
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Provider Name | TAMARA BACA RDH MPH
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Gender | Female
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Dates
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Enumeration Date | 10/19/2016
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Last Update Date | 12/13/2016
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Provider Practice Location Address
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Address Line | 635 E BASELINE RD
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City | PHOENIX
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State | AZ
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Zip | 85042-6551
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Country | US
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Telephone | 602-243-7277
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Fax |
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Provider Business Mailing Address
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Address Line | 714 E TAYLOR ST
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City | TEMPE
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State | AZ
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Zip | 85281-1158
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Country | US
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Telephone | 602-818-8778
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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 | H04531
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License Number State | AZ
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