Provider Demographics
NPI:1306662309
Name:TAJON, SANDRA JAMILLA (RDH)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:JAMILLA
Last Name:TAJON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-3525 KAULUAKOKO ST UNIT 1814
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-6872
Mailing Address - Country:US
Mailing Address - Phone:808-729-0706
Mailing Address - Fax:
Practice Address - Street 1:DESMOND T. DOSS HEALTH CLINIC
Practice Address - Street 2:BLDG 683
Practice Address - City:SCHOFIELD BARRACKS
Practice Address - State:HI
Practice Address - Zip Code:96786
Practice Address - Country:US
Practice Address - Phone:808-433-6825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDH-2120124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist