Provider Demographics
NPI:1619279577
Name:PANTANO, TAMATHA CAUDILL (DMD)
Entity Type:Individual
Prefix:DR
First Name:TAMATHA
Middle Name:CAUDILL
Last Name:PANTANO
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 1:8918 WOODYARD RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-4204
Mailing Address - Country:US
Mailing Address - Phone:301-856-1122
Mailing Address - Fax:301-856-1759
Practice Address - Street 1:8918 WOODYARD RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-4204
Practice Address - Country:US
Practice Address - Phone:301-856-1222
Practice Address - Fax:301-856-1759
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-29
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY88801223G0001X
MD148221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice