Provider Demographics
NPI:1588198535
Name:AIKEN, TAMMIE JO (RDH)
Entity Type:Individual
Prefix:
First Name:TAMMIE
Middle Name:JO
Last Name:AIKEN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 N BYERS AVE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-2775
Mailing Address - Country:US
Mailing Address - Phone:417-396-1881
Mailing Address - Fax:
Practice Address - Street 1:4016 MAIN ST
Practice Address - Street 2:
Practice Address - City:CASSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65625-9753
Practice Address - Country:US
Practice Address - Phone:417-847-0057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003301124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist