=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508003344
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL O TOLHURST DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2009
-----------------------------------------------------
Last Update Date | 01/15/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 42112 WASHINGTON ST SUITE 1F
-----------------------------------------------------
City | BERMUDA DUNES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92203-8163
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-360-9274
-----------------------------------------------------
Fax | 760-345-4902
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 42112 WASHINGTON ST SUITE 1F
-----------------------------------------------------
City | BERMUDA DUNES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92203-8163
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-360-9274
-----------------------------------------------------
Fax | 760-345-4902
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 39486
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 39486
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------