Provider Demographics
NPI:1114923521
Name:CREAMER, TARA JENSEN (DDS)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:JENSEN
Last Name:CREAMER
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 1:918 CHESAPEAKE AVE
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-3132
Mailing Address - Country:US
Mailing Address - Phone:410-268-8701
Mailing Address - Fax:410-268-0403
Practice Address - Street 1:918 CHESAPEAKE AVE
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-3132
Practice Address - Country:US
Practice Address - Phone:410-268-8701
Practice Address - Fax:410-268-0403
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD133731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice