Provider Demographics
NPI:1497213342
Name:SEARS, TARA LYNN (DDS)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:LYNN
Last Name:SEARS
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 1:2215 23RD ST
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3875
Mailing Address - Country:US
Mailing Address - Phone:563-340-9277
Mailing Address - Fax:
Practice Address - Street 1:3445 SALIDA ST STE 30
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-5000
Practice Address - Country:US
Practice Address - Phone:303-366-3383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-11
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CO002043391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program