Provider Demographics
NPI:1720106677
Name:TAMETA, JOCELYN P (DDS)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:P
Last Name:TAMETA
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 1:839 NEW LOUDON RD
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-6101
Mailing Address - Country:US
Mailing Address - Phone:518-783-7932
Mailing Address - Fax:518-785-6115
Practice Address - Street 1:839 NEW LOUDON RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-6101
Practice Address - Country:US
Practice Address - Phone:518-783-7932
Practice Address - Fax:518-785-6115
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY44570122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY52-2402492OtherTAX ID#