Provider Demographics
NPI:1689989600
Name:HOLLIDAY, TAMARA REIKO (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:REIKO
Last Name:HOLLIDAY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11021 EVANSTON AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8218
Mailing Address - Country:US
Mailing Address - Phone:206-779-5066
Mailing Address - Fax:
Practice Address - Street 1:11021 EVANSTON AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8218
Practice Address - Country:US
Practice Address - Phone:206-779-5066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE601721931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice