Provider Demographics
NPI:1407890056
Name:ADAMS, TAMMIE LAJUANA (DMD)
Entity Type:Individual
Prefix:DR
First Name:TAMMIE
Middle Name:LAJUANA
Last Name:ADAMS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MS
Other - First Name:TAMMIE
Other - Middle Name:LAJUANA
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:2604 S VERMONT AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-2298
Mailing Address - Country:US
Mailing Address - Phone:323-731-3333
Mailing Address - Fax:323-731-7626
Practice Address - Street 1:20707 ANZA AVE
Practice Address - Street 2:APT # 271
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-2925
Practice Address - Country:US
Practice Address - Phone:424-247-7235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3094122300000X
CA56262CA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00660254Medicaid