Provider Demographics
NPI:1558588459
Name:HIESTER, TAMARA L (DDS)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:L
Last Name:HIESTER
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 1:105 COMMUNITY DR
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-1955
Mailing Address - Country:US
Mailing Address - Phone:812-524-2424
Mailing Address - Fax:812-524-2727
Practice Address - Street 1:320 W 2ND ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2148
Practice Address - Country:US
Practice Address - Phone:812-524-2424
Practice Address - Fax:812-524-2727
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120097651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice