Provider Demographics
NPI:1548809379
Name:DILLOW, TARA MARIE
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:MARIE
Last Name:DILLOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354TH MDOS/SGOD
Mailing Address - Street 2:2630 CENTRAL AVE STE 1M07
Mailing Address - City:EIELSON AFB
Mailing Address - State:AK
Mailing Address - Zip Code:99702-2397
Mailing Address - Country:US
Mailing Address - Phone:907-377-6767
Mailing Address - Fax:
Practice Address - Street 1:354TH MDOS/SGOD
Practice Address - Street 2:2630 CENTRAL AVE STE 1M07
Practice Address - City:EIELSON AFB
Practice Address - State:AK
Practice Address - Zip Code:99702-2397
Practice Address - Country:US
Practice Address - Phone:907-377-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-26
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant