Provider Demographics
NPI:1972590289
Name:DIAMOND, TAMAR D (DMD)
Entity Type:Individual
Prefix:
First Name:TAMAR
Middle Name:D
Last Name:DIAMOND
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:PO BOX 746
Mailing Address - Street 2:
Mailing Address - City:BINGHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04920-0746
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:237 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BINGHAM
Practice Address - State:ME
Practice Address - Zip Code:04920
Practice Address - Country:US
Practice Address - Phone:207-672-3519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5407122300000X
MEDEN4227122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist