Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 31781 | TX |
N | 213EG0000X | General Practice | 31781 | TX |
Y | 1223P0221X | Pediatric Dentist | 31781 | TX |
NPI | 1043505365 |
---|---|
Provider Name | Dr. Dona Taherizadegan |
First Address | Fort Polk, LA 71459-3419 |
Second Address | Fort Polk, LA 71459-3419 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2011 |
Last Update Date | 03/08/2020 |