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General NPI Number Information
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NPI Number | 1558478917
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Entity Type | Organization
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Legal Business Name | KEVIN P. TOLLIVER, D.D.S., P.C.
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8805 N MERIDIAN ST SUITE 200
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City | INDIANAPOLIS
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State | IN
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Zip | 46260-2332
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Country | US
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Telephone | 317-571-5000
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Fax | 317-571-5010
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Provider Business Mailing Address
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Address Line | 8805 N MERIDIAN ST SUITE 200
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City | INDIANAPOLIS
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State | IN
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Zip | 46260-2332
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Country | US
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Telephone | 317-571-5000
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Fax | 317-571-5010
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEVIN PAUL TOLLIVER
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Credential | D.D.S.
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Telephone | 317-571-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12007532
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License Number State | IN
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