Provider Demographics
NPI:1164718227
Name:DROZDOWSKI, TINA NICHOLE (RDH)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:NICHOLE
Last Name:DROZDOWSKI
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1059 BARTON DR
Mailing Address - Street 2:
Mailing Address - City:FORDLAND
Mailing Address - State:MO
Mailing Address - Zip Code:65652-7350
Mailing Address - Country:US
Mailing Address - Phone:417-767-2100
Mailing Address - Fax:417-767-4054
Practice Address - Street 1:1059 BARTON DR
Practice Address - Street 2:
Practice Address - City:FORDLAND
Practice Address - State:MO
Practice Address - Zip Code:65652-7350
Practice Address - Country:US
Practice Address - Phone:417-767-2100
Practice Address - Fax:417-767-4054
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008017399124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist