Healthcare Provider Details

I. General information

NPI: 1962799502
Provider Name (Legal Business Name): TARYN MARIE POGODA D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2011
Last Update Date: 01/11/2021
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6760 ABRAMS RD STE 201
DALLAS TX
75231-0245
US

IV. Provider business mailing address

6760 ABRAMS RD STE 201
DALLAS TX
75231-0245
US

V. Phone/Fax

Practice location:
  • Phone: 214-349-9455
  • Fax:
Mailing address:
  • Phone: 908-705-4971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI02474800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number31759
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: