Individual
DR. TAMARA BLISS WORTHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1103 WALNUT DR, ARDMORE, OK 73401-2354
(580) 226-6290
(580) 223-4381
Mailing address
1103 WALNUT DR, PEDIATRIC DENTAL ASSOCIATES PC, ARDMORE, OK 73401-2354
(580) 226-6290
(580) 223-4381
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
5248
OK
122300000X
Dentist
7780
CO
1223P0221X
Pediatric Dentistry
Primary
5248
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100091120A
—
OK
05
—
100091120B
—
OK
05
—
100182220C
—
OK
Enumeration date
10/14/2006
Last updated
09/27/2013
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