Provider Demographics
NPI:1639844491
Name:DODD, TANEESHA
Entity Type:Individual
Prefix:
First Name:TANEESHA
Middle Name:
Last Name:DODD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2408 NW 52ND ST APT F7
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-1437
Mailing Address - Country:US
Mailing Address - Phone:580-917-6108
Mailing Address - Fax:
Practice Address - Street 1:2408 NW 52ND ST APT F7
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-1437
Practice Address - Country:US
Practice Address - Phone:580-917-6108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist