=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871908517
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLEN & TATEM, DDS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2014
-----------------------------------------------------
Last Update Date | 06/20/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10705 SPOTSYLVANIA AVE STE. 102
-----------------------------------------------------
City | FREDERICKSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22408-2675
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-891-5521
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10705 SPOTSYLVANIA AVE STE. 102
-----------------------------------------------------
City | FREDERICKSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22408-2675
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-891-5521
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/PARTNER
-----------------------------------------------------
Name | DR. TAURUS KELLEY TATEM
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 540-891-5521
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 0401410327
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------