Provider Demographics
NPI:1962799502
Name:POGODA, TARYN MARIE (DMD)
Entity type:Individual
Prefix:
First Name:TARYN
Middle Name:MARIE
Last Name:POGODA
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 1:6760 ABRAMS RD STE 201
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-0245
Mailing Address - Country:US
Mailing Address - Phone:908-705-4971
Mailing Address - Fax:
Practice Address - Street 1:6760 ABRAMS RD STE 201
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-0245
Practice Address - Country:US
Practice Address - Phone:214-349-9455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-04
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02474800122300000X
390200000X
TX317591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program