Individual
MARTIN A TAHARA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DMD, MD
Contact information
Practice address
1701 CURVE CREST BLVD W, SUITE 108, STILLWATER, MN 55082-6044
(651) 439-8030
(651) 351-0821
Mailing address
1701 CURVE CREST BLVD W, SUITE 108, STILLWATER, MN 55082-6044
(651) 439-8030
(651) 351-0821
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
5219-015
WI
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D11409
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33761200
—
WI
Enumeration date
01/23/2006
Last updated
07/09/2007
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