Provider Demographics
NPI:1114605268
Name:INSUA, TAMARA (DMD)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:INSUA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 E 41ST ST STE 202
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-2463
Mailing Address - Country:US
Mailing Address - Phone:305-836-3635
Mailing Address - Fax:
Practice Address - Street 1:820 E 41ST ST STE 202
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-2463
Practice Address - Country:US
Practice Address - Phone:305-836-3635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL283561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice