Provider Demographics
NPI:1891519617
Name:MICHAEL E. TAMM DMD PLLC
Entity type:Organization
Organization Name:MICHAEL E. TAMM DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:TAMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-892-4616
Mailing Address - Street 1:882 CAPITAL AVE SW
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-3584
Mailing Address - Country:US
Mailing Address - Phone:269-963-8256
Mailing Address - Fax:
Practice Address - Street 1:882 CAPITAL AVE SW
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-3584
Practice Address - Country:US
Practice Address - Phone:269-963-8256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-08
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1598898702Medicaid