Provider Demographics
NPI:1942676606
Name:TAMARA LYN DUNLAP DDS PLLC
Entity Type:Organization
Organization Name:TAMARA LYN DUNLAP DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNLAP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-762-4321
Mailing Address - Street 1:310 JANSEN AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12095-1909
Mailing Address - Country:US
Mailing Address - Phone:518-762-4321
Mailing Address - Fax:518-762-4323
Practice Address - Street 1:310 JANSEN AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095-1909
Practice Address - Country:US
Practice Address - Phone:518-762-4321
Practice Address - Fax:518-762-4323
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAMARA LYN DUNLAP DDS PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0485151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03016277Medicaid
NY9210579OtherDENTAQUEST