MEDICARE: ERIC TAMSUT, DMD INC.

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	261QD0000X	Dental Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	E3231383	OTHER	CA	DRIVER LICENSE

General Provider Information

NPI Number	:	1780297358
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERIC TAMSUT, DMD INC.

Provider Business Mailing Address
First Line	:	1230 KIRKFORD WAY
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-3722
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3615 LAS POSAS RD STE 145
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93010-1428
Country	:	US
Telephone Number	:	818-661-8338
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. ERIC TAMSUT
Credential	:
Telephone Number	:	818-661-8338

Provider Enumeration Date	:	08/24/2020
Last Update Date	:	08/24/2020

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