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Individual
MISS TANYA WANDA POWELL
Active
Individual
MISS TANYA WANDA POWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6321
NE
1223G0001X
General Practice Dentistry
6321
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05691
BLUECROSS BLUESHIELD
NE
05
—
100249672-00
—
NE
Enumeration date
10/24/2006
Last updated
06/05/2024
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