Healthcare Provider Details

I. General information

NPI: 1962852707
Provider Name (Legal Business Name): JOSEPH TOALE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2016
Last Update Date: 06/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 21ST ST
MILFORD IA
51351-7421
US

IV. Provider business mailing address

1004 21ST ST
MILFORD IA
51351-7421
US

V. Phone/Fax

Practice location:
  • Phone: 712-338-2449
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS-09293
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: