Provider Demographics
NPI:1760464101
Name:DONALD, TAMARA LOUISE (RDH)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:LOUISE
Last Name:DONALD
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 710
Mailing Address - Street 2:
Mailing Address - City:PECOS
Mailing Address - State:NM
Mailing Address - Zip Code:87552-0710
Mailing Address - Country:US
Mailing Address - Phone:505-757-6666
Mailing Address - Fax:505-873-7444
Practice Address - Street 1:199 NM-50
Practice Address - Street 2:
Practice Address - City:PECOS
Practice Address - State:NM
Practice Address - Zip Code:87552-8701
Practice Address - Country:US
Practice Address - Phone:505-757-6666
Practice Address - Fax:505-757-6968
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDH2409124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist