Provider Demographics
NPI:1235688474
Name:RESARE, TAMIE
Entity Type:Individual
Prefix:MRS
First Name:TAMIE
Middle Name:
Last Name:RESARE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAMIE
Other - Middle Name:
Other - Last Name:ZUERCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EFDA
Mailing Address - Street 1:10209 SE SUNNYSIDE RD
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-9782
Mailing Address - Country:US
Mailing Address - Phone:503-335-3390
Mailing Address - Fax:
Practice Address - Street 1:10209 SE SUNNYSIDE RD
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9782
Practice Address - Country:US
Practice Address - Phone:503-335-3390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR118094126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant