Provider Demographics
NPI:1427133982
Name:HALD, TAMARA SHAWN (DDS)
Entity type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:SHAWN
Last Name:HALD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 E MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2162
Mailing Address - Country:US
Mailing Address - Phone:541-482-1551
Mailing Address - Fax:541-482-2102
Practice Address - Street 1:485 E MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2162
Practice Address - Country:US
Practice Address - Phone:541-482-1551
Practice Address - Fax:541-482-2102
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR80791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice