Provider Demographics
NPI:1033103544
Name:HONOLD, TAMMY LARK (RDH)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:LARK
Last Name:HONOLD
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 SAGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:IGNACIO
Mailing Address - State:CO
Mailing Address - Zip Code:81137-9100
Mailing Address - Country:US
Mailing Address - Phone:970-563-4581
Mailing Address - Fax:970-563-0206
Practice Address - Street 1:123 HWY 172
Practice Address - Street 2:
Practice Address - City:IGNACIO
Practice Address - State:CO
Practice Address - Zip Code:81137
Practice Address - Country:US
Practice Address - Phone:970-563-4581
Practice Address - Fax:970-563-0206
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO201905124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist