Provider Demographics
NPI:1245538693
Name:SEXTON, TARA (DMD)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:
Last Name:SEXTON
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 1:8 CYNWYD RD
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-3345
Mailing Address - Country:US
Mailing Address - Phone:610-664-8466
Mailing Address - Fax:610-664-9882
Practice Address - Street 1:8 CYNWYD RD
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3345
Practice Address - Country:US
Practice Address - Phone:610-664-8466
Practice Address - Fax:610-664-9882
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026231-L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist