Provider Demographics
NPI:1225145634
Name:GOUGH, TAMELA L (DDS, MS)
Entity Type:Individual
Prefix:
First Name:TAMELA
Middle Name:L
Last Name:GOUGH
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Gender:F
Credentials:DDS, MS
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Mailing Address - Street 1:201 N ALMA DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-3337
Mailing Address - Country:US
Mailing Address - Phone:972-727-0737
Mailing Address - Fax:972-727-5583
Practice Address - Street 1:201 N ALMA DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-3337
Practice Address - Country:US
Practice Address - Phone:972-727-0737
Practice Address - Fax:972-727-5583
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX155021223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry