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Individual

TARA FERRIS STREAM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DDS

Contact information

Practice address
601 BUFFALO ST, MANITOWOC, WI 54220-6817
(920) 686-2333
(920) 783-6392
Mailing address
PO BOX 959, SHEBOYGAN, WI 53082-0959
(920) 783-6633
(920) 783-6392

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7234-15
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100037927
WI
Enumeration date
05/30/2014
Last updated
02/18/2016
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