Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 0550321 | NY |
NPI | 1043525488 |
---|---|
Provider Name | Dr. Michelle K Tunison |
First Address | Vestal, NY 13850 |
Second Address | Vestal, NY 13850 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2010 |
Last Update Date | 04/09/2018 |