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General NPI Number Information
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NPI Number | 1881819480
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Entity Type | Organization
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Legal Business Name | ROBERT C. TOLLE, D.D.S., P.A.
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1209 DAVIE AVE
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City | STATESVILLE
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State | NC
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Zip | 28677-3511
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Country | US
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Telephone | 704-872-8934
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Fax | 704-873-0426
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Provider Business Mailing Address
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Address Line | 1209 DAVIE AVE
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City | STATESVILLE
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State | NC
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Zip | 28677-3511
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Country | US
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Telephone | 704-872-8934
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Fax | 704-873-0426
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | SUSAN TOLLE
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Credential |
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Telephone | 704-872-8934
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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 | 6730
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License Number State | NC
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