Provider Demographics
NPI:1992874549
Name:CARLOS A TAMAYO DDS INC
Entity type:Organization
Organization Name:CARLOS A TAMAYO DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:TAMAYO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-483-9567
Mailing Address - Street 1:710 S B ST
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-7176
Mailing Address - Country:US
Mailing Address - Phone:805-483-9567
Mailing Address - Fax:805-483-7997
Practice Address - Street 1:710 S B ST
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-7176
Practice Address - Country:US
Practice Address - Phone:805-483-9567
Practice Address - Fax:805-483-7997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38609122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty