MEDICARE: DR. TAMARA MICHELLE TASOFF DDS

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
1	122300000X	Dentist	37213	TX
2	122300000X	Dentist	110937	CA

General Provider Information

NPI Number	:	1770226268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAMARA MICHELLE TASOFF DDS

Provider Business Mailing Address
First Line	:	5784 LINDERO CANYON RD STE B
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91362-4088
Country	:	US
Telephone Number	:	818-516-9080
Fax Number	:

Provider Business Practice Location Address
First Line	:	5784 LINDERO CANYON RD STE B
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91362-4088
Country	:	US
Telephone Number	:	818-706-0131
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2022
Last Update Date	:	02/05/2025

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