Provider Demographics
NPI:1457581159
Name:FERNANDES, TAMARA BILL (DDS)
Entity type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:BILL
Last Name:FERNANDES
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 N PINES RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-4936
Mailing Address - Country:US
Mailing Address - Phone:509-924-6262
Mailing Address - Fax:
Practice Address - Street 1:1107 N PINES RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4936
Practice Address - Country:US
Practice Address - Phone:509-924-6262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60802203122300000X
CO202059122300000X
CA635861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes122300000XDental ProvidersDentist