Provider Demographics
NPI:1639618325
Name:VOLLMER, TABITHA (RDH)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:VOLLMER
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 1:1701 W SUNSHINE
Mailing Address - Street 2:SUITE Q
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-2261
Mailing Address - Country:US
Mailing Address - Phone:417-501-1048
Mailing Address - Fax:417-501-1661
Practice Address - Street 1:1701 W. SUNSHINE STREET
Practice Address - Street 2:SUITE Q
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-2261
Practice Address - Country:US
Practice Address - Phone:417-501-1048
Practice Address - Fax:417-501-1661
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016004424126800000X
MO2012022466124Q00000X
MO2016004425126800000X
MO2016004427126800000X
MO2016004422126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No126800000XDental ProvidersDental Assistant