Provider Demographics
NPI:1730449893
Name:RONGONE, TAMMY LORAINE
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:LORAINE
Last Name:RONGONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 2 2 181ST.AVE
Mailing Address - Street 2:822
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-6708
Mailing Address - Country:US
Mailing Address - Phone:503-661-5210
Mailing Address - Fax:503-669-3989
Practice Address - Street 1:822 N.E. 181ST. AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-6708
Practice Address - Country:US
Practice Address - Phone:503-661-5210
Practice Address - Fax:503-669-3989
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant