Provider Demographics
NPI:1598332470
Name:JANDALI, TAMARA (DMD)
Entity Type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:
Last Name:JANDALI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 SW ARCHER RD # D10-6
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0434
Mailing Address - Country:US
Mailing Address - Phone:352-273-8360
Mailing Address - Fax:352-273-6192
Practice Address - Street 1:1600 SW ARCHER RD # D10-6
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3006
Practice Address - Country:US
Practice Address - Phone:352-273-7954
Practice Address - Fax:352-273-6192
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDPR23271223P0300X
FLDRPM23271223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics