Provider Demographics
NPI:1235278847
Name:KARELIS, TAMARA WHITE (DMD)
Entity type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:WHITE
Last Name:KARELIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-1973
Mailing Address - Country:US
Mailing Address - Phone:606-487-9505
Mailing Address - Fax:606-487-0758
Practice Address - Street 1:279 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-1920
Practice Address - Country:US
Practice Address - Phone:606-487-9505
Practice Address - Fax:606-436-0071
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7281122300000X, 1223D0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
No1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60001609Medicaid
KY45002227Medicaid