Organization
KTAM DDS DENTAL CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH TAM DDS (CEO)
(949) 322-9778
Entity
Organization
Contact information
Practice address
1505 SHEPARD DR, #201, SANTA MARIA, CA 93454-7020
(949) 322-9778
Mailing address
1505 SHEPARD DR, #201, SANTA MARIA, CA 93454-7020
(949) 322-9778
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
57293
CA
Other
Enumeration date
08/12/2010
Last updated
10/08/2010
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