1568815520 NPI number — TAMARA L. CLAUSON, DDS, A PROFESSIONAL CORPORATION

Table of content: (NPI 1568815520)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568815520 NPI number — TAMARA L. CLAUSON, DDS, A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TAMARA L. CLAUSON, DDS, A PROFESSIONAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568815520
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1101 W TOKAY ST
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
LODI
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95240-3842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-334-2821
Provider Business Mailing Address Fax Number:
209-365-6228

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 W TOKAY ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
LODI
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95240-3842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-334-2821
Provider Business Practice Location Address Fax Number:
209-365-6228
Provider Enumeration Date:
07/14/2016

Additional Information

Authorized Official

Authorized Official Last Name:
CLAUSON
Authorized Official First Name:
TAMARA
Authorized Official Middle Name:
LEA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
209-334-2821

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  32548 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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