Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DN11908 | FL |
NPI | 1114992013 |
---|---|
Provider Name | Dr. Tonya Pollard |
First Address | Panama City, FL 32404 |
Second Address | Panama City, FL 32404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 25/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
070935200 | (05) | FL |