Provider Demographics
NPI:1053170290
Name:SAVAGE, TARA (IPDH)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:IPDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 BARKER RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:ME
Mailing Address - Zip Code:04217-3222
Mailing Address - Country:US
Mailing Address - Phone:207-357-2952
Mailing Address - Fax:
Practice Address - Street 1:44 MAYVILLE RD
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:ME
Practice Address - Zip Code:04217-4400
Practice Address - Country:US
Practice Address - Phone:207-357-2952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERDH4102124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist