# TAMARA EATON DDS PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245605542
- **Authorized official:** CANDACE WILDE (PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (219) 210-3495

## Contact information

- **Practice address:** 1213 E COOLSPRING AVE, MICHIGAN CITY, IN 46360-6319
- **Practice address phone:** (219) 872-9151
- **Practice address fax:** (219) 873-3341
- **Mailing address:** 1213 E COOLSPRING AVE, MICHIGAN CITY, IN 46360-6319

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12009857A | IN | Yes |

## Other

- **Enumeration date:** 12/11/2015
- **Last updated:** 12/11/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200384300A | — | IN |