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General NPI Number Information
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NPI Number | 1043757677
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Entity Type | Individual
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Provider Name | KAREN TOLLIVER
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Gender | Female
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Dates
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Enumeration Date | 01/20/2017
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Last Update Date | 01/20/2017
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Provider Practice Location Address
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Address Line | 7770 SIGHTSEEING RD, BLDG 2828
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City | FORT BENNING
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State | GA
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Zip | 31905
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Country | US
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Telephone | 706-545-3956
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Fax |
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Provider Business Mailing Address
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Address Line | 7770 SIGHTSEEING RD, BLDG 2828
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City | FORT BENNING
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State | GA
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Zip | 31905
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 11317
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 7795
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 5689
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License Number State | TN
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