Provider Demographics
NPI:1164629929
Name:BENJAMIN L. TOLLEY, D.D.S., P.C.
Entity Type:Organization
Organization Name:BENJAMIN L. TOLLEY, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:TOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-662-6466
Mailing Address - Street 1:36 W WHITLOCK AVE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-4432
Mailing Address - Country:US
Mailing Address - Phone:540-662-6466
Mailing Address - Fax:540-662-6695
Practice Address - Street 1:36 W WHITLOCK AVE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-4432
Practice Address - Country:US
Practice Address - Phone:540-662-6466
Practice Address - Fax:540-662-6695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411543122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty