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NPI Code Detail

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

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
11223P0106XOral and Maxillofacial Pathology Dentistry3472NH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID 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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