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NPI Code Detail

MEDICARE: DR. TARA KHAMO D.D.S

MEDICARE: DR. TARA KHAMO D.D.S
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryRES.004134OH
2122300000XDentist100221CA

General Provider Information

NPI Number : 1639521404
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TARA KHAMO D.D.S
Provider Business Mailing Address
First Line : 4071 LEE RD STE 260
Second Line :
City : CLEVELAND
State : OH
Zip : 44128-2173
Country : US
Telephone Number : 216-861-6200
Fax Number : 216-363-7490
Provider Business Practice Location Address
First Line : 4071 LEE RD STE 260
Second Line :
City : CLEVELAND
State : OH
Zip : 44128-2173
Country : US
Telephone Number : 216-861-6200
Fax Number : 216-363-7490
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2016
Last Update Date : 06/15/2019

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