Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 22295 | CA |
NPI | 1962628651 |
---|---|
Provider Name | Dr. John Harold Tolin |
First Address | Santa Rosa, CA 95405-7800 |
Second Address | Santa Rosa, CA 95405-7800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2007 |
Last Update Date | 08/07/2007 |