Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204E00000X | Oral & Maxillofacial Surgeon | 3394 | NE |
Y | 204E00000X | Oral & Maxillofacial Surgeon | D6934 | MN |
NPI | 1326296120 |
---|---|
Provider Name | Dan E Tolman |
First Address | Rochester, MN 55905-0001 |
Second Address | Rochester, MN 55902-1168 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2008 |
Last Update Date | 24/09/2008 |