Provider Demographics
NPI:1568815520
Name:TAMARA L. CLAUSON, DDS, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:TAMARA L. CLAUSON, DDS, A PROFESSIONAL CORPORATION
Other - Org Name:TLC DENTAL CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:CLAUSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-334-2821
Mailing Address - Street 1:1101 W TOKAY ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-3842
Mailing Address - Country:US
Mailing Address - Phone:209-334-2821
Mailing Address - Fax:209-365-6228
Practice Address - Street 1:1101 W TOKAY ST
Practice Address - Street 2:SUITE 1
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-3842
Practice Address - Country:US
Practice Address - Phone:209-334-2821
Practice Address - Fax:209-365-6228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA325481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty