Provider Demographics
NPI:1952159378
Name:ELSEN, TAMARA LILLOUX (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:LILLOUX
Last Name:ELSEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:LILLOUX
Other - Last Name:SHASKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1184 ENCANTO CT
Mailing Address - Street 2:
Mailing Address - City:BLYTHE
Mailing Address - State:CA
Mailing Address - Zip Code:92225-1084
Mailing Address - Country:US
Mailing Address - Phone:760-501-5738
Mailing Address - Fax:
Practice Address - Street 1:1090 ARNOLD DR # 1090
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72099-4933
Practice Address - Country:US
Practice Address - Phone:501-987-8811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program