Provider Demographics
NPI:1548324775
Name:VWICH, TAMARA BAJJ (DDS)
Entity type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:BAJJ
Last Name:VWICH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:TAMARA
Other - Middle Name:FAWZI
Other - Last Name:BAJJ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3011 RANCHO VISTA BLVD
Mailing Address - Street 2:SUITE I
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-4821
Mailing Address - Country:US
Mailing Address - Phone:661-266-9785
Mailing Address - Fax:661-267-5874
Practice Address - Street 1:3011 RANCHO VISTA BLVD
Practice Address - Street 2:SUITE I
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-4821
Practice Address - Country:US
Practice Address - Phone:661-266-9785
Practice Address - Fax:661-267-5874
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52128122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist