Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 340761-9922 | UT |
NPI | 1013109750 |
---|---|
Provider Name | Aaron Olester Tolman |
First Address | Spanish Fork, UT 84660-9513 |
Second Address | Spanish Fork, UT 84660-9513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2007 |
Last Update Date | 16/08/2007 |