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NPI Code Detail

MEDICARE: DR. TAMARA POLIDOR D.M.D

MEDICARE: DR. TAMARA POLIDOR D.M.D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryDSO27721LPA

General Provider Information

NPI Number : 1902986193
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TAMARA POLIDOR D.M.D
Provider Business Mailing Address
First Line : 238 W ALLEGHENY RD
Second Line :
City : IMPERIAL
State : PA
Zip : 15126-9775
Country : US
Telephone Number : 724-695-8447
Fax Number : 724-695-4688
Provider Business Practice Location Address
First Line : 238 W ALLEGHENY RD
Second Line :
City : IMPERIAL
State : PA
Zip : 15126-9775
Country : US
Telephone Number : 724-695-8447
Fax Number : 724-695-4688
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/16/2006
Last Update Date : 07/08/2007

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