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General NPI Number Information
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NPI Number | 1730756073
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Entity Type | Individual
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Provider Name | KERRY CANNON TOLOSKY DMD
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Gender | Female
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Dates
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Enumeration Date | 06/07/2021
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Last Update Date | 08/19/2024
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Provider Practice Location Address
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Address Line | 2993 MAIN ST
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City | PERU
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State | NY
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Zip | 12972-2927
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Country | US
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Telephone | 518-282-5519
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Fax |
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Provider Business Mailing Address
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Address Line | 159 SUNRISE DR
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City | PLATTSBURGH
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State | NY
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Zip | 12901-5336
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Country | US
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Telephone | 518-569-3244
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 016.0134019
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 063568
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License Number State | NY
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