Provider Demographics
NPI:1457492902
Name:VOLKOVA, TAMARA (DMD)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:VOLKOVA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 2ND AVE STE D-500
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-3641
Mailing Address - Country:US
Mailing Address - Phone:610-409-9370
Mailing Address - Fax:610-409-9890
Practice Address - Street 1:555 2ND AVE STE D-500
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-3641
Practice Address - Country:US
Practice Address - Phone:610-409-9370
Practice Address - Fax:610-409-9890
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031441L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist