Provider Demographics
NPI:1316019417
Name:TOLMACH, IVANNA (DMD)
Entity Type:Individual
Prefix:DR
First Name:IVANNA
Middle Name:
Last Name:TOLMACH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3239 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-1590
Mailing Address - Country:US
Mailing Address - Phone:541-343-8206
Mailing Address - Fax:
Practice Address - Street 1:2703 DELTA OAKS DR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97408-1700
Practice Address - Country:US
Practice Address - Phone:503-952-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD78261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice