Provider Demographics
NPI:1679958326
Name:MERCHANT, TAMMY N (DHAT)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:N
Last Name:MERCHANT
Suffix:
Gender:F
Credentials:DHAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 S KNIK GOOSE BAY RD
Mailing Address - Street 2:DENTAL
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-8083
Mailing Address - Country:US
Mailing Address - Phone:907-729-2000
Mailing Address - Fax:907-729-5178
Practice Address - Street 1:1001 S KNIK GOOSE BAY RD
Practice Address - Street 2:DENTAL
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8083
Practice Address - Country:US
Practice Address - Phone:907-729-2000
Practice Address - Fax:907-729-5178
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK06027DHAT125J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125J00000XDental ProvidersDental Therapist