Provider Demographics
NPI:1912559840
Name:NATH, TARA DEVI (DMD)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:DEVI
Last Name:NATH
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 1:604 W 34TH ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23508-3142
Mailing Address - Country:US
Mailing Address - Phone:727-458-2982
Mailing Address - Fax:
Practice Address - Street 1:4520 PRETTY LAKE AVE STE 201
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518-1826
Practice Address - Country:US
Practice Address - Phone:757-699-5847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35339122300000X
VA04014190701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice