Provider Demographics
NPI:1396958039
Name:HIMMER, TAMARA LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:LYNN
Last Name:HIMMER
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 1:147 GRANVILLE ST
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-3005
Mailing Address - Country:US
Mailing Address - Phone:614-418-9660
Mailing Address - Fax:614-418-9662
Practice Address - Street 1:147 GRANVILLE ST
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-3005
Practice Address - Country:US
Practice Address - Phone:614-418-9660
Practice Address - Fax:614-418-9662
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH201041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice