Provider Demographics
NPI:1003554304
Name:TACHAGO KAMDOM, ESTELLE SONYA (DDS)
Entity Type:Individual
Prefix:MISS
First Name:ESTELLE SONYA
Middle Name:
Last Name:TACHAGO KAMDOM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 N CHARLES ST APT 705
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-4078
Mailing Address - Country:US
Mailing Address - Phone:313-627-3157
Mailing Address - Fax:
Practice Address - Street 1:35 E KEMPER RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-3224
Practice Address - Country:US
Practice Address - Phone:513-642-0002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH30.026900122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program