Tara Rene Dohm, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

2901601288 Issued in MI

Practice address

2600 Lafranier Rd
Traverse City, MI 49686-4765

Phone

(866) 878-6557

NPI assigned

Jun 29, 2022

Last updated

Jun 29, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Ms. Tara Rene Wisniewski Former name

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1656460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656460800000",
    "number": "1184356032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3488 MAHONEY DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496969001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 LAFRANIER RD",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496864765",
            "telephone_number": "866-878-6557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOHM",
        "first_name": "TARA",
        "middle_name": "RENE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-06-29",
        "last_updated": "2022-06-29",
        "certification_date": "2022-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901601288",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TARA",
            "last_name": "WISNIEWSKI",
            "middle_name": "RENE",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Rebecca R. Dobler, LMSW
• Stacy Zachman Dobreff, PA-C
• Shannon Dodds, LMSW
• Thomas R Doerr, M.D.
• Christopher Doherty
• Elizabeth Ann Dole, FAACVPR
• Joseph Dombrowski, HIS
• Maggie Domres
• Holly Beth Donaldson, DC
• Jill Marie Donberg, MACOM, DIPL. OM

• Dentist in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.