Provider Demographics
NPI:1417784315
Name:TAMARA SARDAR DDS PLLC
Entity type:Organization
Organization Name:TAMARA SARDAR DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:SARDAR
Authorized Official - Last Name:AL KARADAGHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-389-4784
Mailing Address - Street 1:120 AVE A
Mailing Address - Street 2:#A
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-2961
Mailing Address - Country:US
Mailing Address - Phone:360-863-2517
Mailing Address - Fax:
Practice Address - Street 1:120 AVE A
Practice Address - Street 2:#A
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2961
Practice Address - Country:US
Practice Address - Phone:360-863-2517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-16
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X2210XDental ProvidersDentistOrofacial PainGroup - Single Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty