Provider Demographics
NPI:1992996045
Name:TAMAYO, CARLOS A (DDS)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:A
Last Name:TAMAYO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-7059
Mailing Address - Country:US
Mailing Address - Phone:805-483-9567
Mailing Address - Fax:805-483-7997
Practice Address - Street 1:441 W 5TH ST
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-7059
Practice Address - Country:US
Practice Address - Phone:805-483-9567
Practice Address - Fax:805-483-7997
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA386091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice