Provider Demographics
NPI:1184845844
Name:TOTTE, TYMON C
Entity Type:Individual
Prefix:
First Name:TYMON
Middle Name:C
Last Name:TOTTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E LONG LAKE RD
Mailing Address - Street 2:STE 311
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304
Mailing Address - Country:US
Mailing Address - Phone:248-203-1119
Mailing Address - Fax:248-723-0052
Practice Address - Street 1:17700 MACK AVE
Practice Address - Street 2:GREAT EXPRESSIONS DENTAL CENTERS
Practice Address - City:GROSS POINTE
Practice Address - State:MI
Practice Address - Zip Code:48224
Practice Address - Country:US
Practice Address - Phone:313-882-2211
Practice Address - Fax:313-882-5434
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018712122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist