Provider Demographics
NPI:1396586319
Name:KAPETANOVIC, TAMARA (DMD)
Entity type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:
Last Name:KAPETANOVIC
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 MILLSTONE CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-7424
Mailing Address - Country:US
Mailing Address - Phone:404-512-5258
Mailing Address - Fax:
Practice Address - Street 1:14422 ORCHARD PKWY # 200
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80023-9272
Practice Address - Country:US
Practice Address - Phone:303-452-0811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00205964122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist