MEDICARE: DR. DANIEL H DE TOLLA D.D.S., M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0106X	Oral and Maxillofacial Pathology Dentistry	3472	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275576829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL H DE TOLLA D.D.S., M.D.

Provider Business Mailing Address
First Line	:	200 GRIFFIN RD
Second Line	:	SUITE 8
City	:	PORTSMOUTH
State	:	NH
Zip	:	03801-7145
Country	:	US
Telephone Number	:	603-436-3608
Fax Number	:	603-436-3646

Provider Business Practice Location Address
First Line	:	200 GRIFFIN RD
Second Line	:	SUITE 8
City	:	PORTSMOUTH
State	:	NH
Zip	:	03801-7145
Country	:	US
Telephone Number	:	603-436-3608
Fax Number	:	603-436-3646

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	09/08/2009

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