Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 061952 | NY |
NPI | 1053975037 |
---|---|
Provider Name | Dr. Tara Earls |
First Address | Melville, NY 11747-1623 |
Second Address | East Patchogue, NY 11772-4869 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2019 |
Last Update Date | 28/09/2021 |