Provider Demographics
NPI:1245750751
Name:TAMARA VWICH DDS INC
Entity type:Organization
Organization Name:TAMARA VWICH DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:BAJJ
Authorized Official - Last Name:VWICH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-266-9785
Mailing Address - Street 1:3011 RANCHO VISTA BLVD ST I
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551
Mailing Address - Country:US
Mailing Address - Phone:661-266-9785
Mailing Address - Fax:661-267-1109
Practice Address - Street 1:3011 RANCHO VISTA BLVD.
Practice Address - Street 2:SUITE I
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551
Practice Address - Country:US
Practice Address - Phone:661-266-9785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-26
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty