Provider Demographics
NPI:1396833562
Name:TSOUZMER, POLINA (DDS)
Entity type:Individual
Prefix:DR
First Name:POLINA
Middle Name:
Last Name:TSOUZMER
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 1:310 N CIVIC DR
Mailing Address - Street 2:APT 309
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-3664
Mailing Address - Country:US
Mailing Address - Phone:415-335-2297
Mailing Address - Fax:
Practice Address - Street 1:1955 TEXAS ST
Practice Address - Street 2:SUITE 12
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-4462
Practice Address - Country:US
Practice Address - Phone:707-428-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA532851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice