Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 3472 | NH |
NPI | 1275576829 |
---|---|
Provider Name | Dr. Daniel H De Tolla |
First Address | Portsmouth, NH 03801-7145 |
Second Address | Portsmouth, NH 03801-7145 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 08/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30303624 | (05) | NH |
U05916 | (02) | NH |