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General NPI Number Information
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NPI Number | 1982519856
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Entity Type | Individual
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Provider Name | TARA ISABELLA OTHMAN DMD
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Gender | Female
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Dates
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Enumeration Date | 08/17/2026
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Last Update Date | 08/17/2026
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Provider Practice Location Address
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Address Line | 5979 35TH ST AND DESERT STORM AVE FORT CAMPBELL, KY
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City | APO
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State | AA
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Zip | 42223
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Country | US
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Telephone | 270-412-8529
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Fax |
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Provider Business Mailing Address
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Address Line | 401 VICTORY RD APT 16B
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City | CLARKSVILLE
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State | TN
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Zip | 37042-2879
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Country | US
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Telephone |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 14295726-8903
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 14295726-9926
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License Number State | UT
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