Provider Demographics
NPI:1114992013
Name:POLLARD, TONYA (DDS)
Entity Type:Individual
Prefix:DR
First Name:TONYA
Middle Name:
Last Name:POLLARD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3518 E. 15TH STREET
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404
Mailing Address - Country:US
Mailing Address - Phone:850-872-4455
Mailing Address - Fax:850-747-5660
Practice Address - Street 1:3518 E. 15TH STREET
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32404
Practice Address - Country:US
Practice Address - Phone:850-872-4455
Practice Address - Fax:850-747-5660
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN119081223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL070935200Medicaid