Healthcare Provider Details

I. General information

NPI: 1760179444
Provider Name (Legal Business Name): POOJA TOLANI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2023
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 COMMACK RD
COMMACK NY
11725-3478
US

IV. Provider business mailing address

5 COMMACK RD
COMMACK NY
11725-3478
US

V. Phone/Fax

Practice location:
  • Phone: 631-499-0040
  • Fax:
Mailing address:
  • Phone: 631-499-0040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number064496
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: