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General NPI Number Information
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NPI Number | 1639618325
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Entity Type | Individual
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Provider Name | TABITHA VOLLMER RDH
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Gender | Female
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Dates
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Enumeration Date | 02/15/2017
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Last Update Date | 02/15/2017
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Provider Practice Location Address
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Address Line | 1701 W. SUNSHINE STREET SUITE Q
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City | SPRINGFIELD
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State | MO
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Zip | 65807-2261
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Country | US
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Telephone | 417-501-1048
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Fax | 417-501-1661
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Provider Business Mailing Address
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Address Line | 1701 W SUNSHINE SUITE Q
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City | SPRINGFIELD
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State | MO
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Zip | 65807-2261
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Country | US
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Telephone | 417-501-1048
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Fax | 417-501-1661
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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 | 126800000X
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Taxonomy Name | Dental Assistant
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License Number | 2016004424
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License Number State | MO
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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 | 2012022466
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number | 2016004425
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number | 2016004427
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License Number State | MO
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Taxonomy #5
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number | 2016004422
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License Number State | MO
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