Provider Demographics
NPI:1285163691
Name:DENTINGER, MICHELLE TAMAYO (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:TAMAYO
Last Name:DENTINGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 477 BOX 2
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96306-0001
Mailing Address - Country:US
Mailing Address - Phone:315-246-3311
Mailing Address - Fax:
Practice Address - Street 1:USNH YOKOSUKA
Practice Address - Street 2:INAOKACHO, 82
Practice Address - City:YOKOSUKA
Practice Address - State:KANAGAWA
Practice Address - Zip Code:2380001
Practice Address - Country:JP
Practice Address - Phone:315-252-3770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA157121207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAVAD000000Medicaid