Provider Demographics
NPI:1770226268
Name:TASOFF, TAMARA MICHELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:MICHELLE
Last Name:TASOFF
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 1:9317 BENTLEY GARNER LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-3093
Mailing Address - Country:US
Mailing Address - Phone:818-516-9080
Mailing Address - Fax:
Practice Address - Street 1:1468 E WHITESTONE BLVD STE 500
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-0019
Practice Address - Country:US
Practice Address - Phone:512-528-5448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37213122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist