Provider Demographics
NPI:1912307133
Name:EGO, TAMIE (DDS)
Entity Type:Individual
Prefix:
First Name:TAMIE
Middle Name:
Last Name:EGO
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:PO BOX 27104
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-7104
Mailing Address - Country:US
Mailing Address - Phone:559-437-0553
Mailing Address - Fax:559-437-0563
Practice Address - Street 1:373 E WARNER AVE
Practice Address - Street 2:STE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-3741
Practice Address - Country:US
Practice Address - Phone:559-437-0553
Practice Address - Fax:559-437-0563
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38274122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist