Provider Demographics
NPI:1326121443
Name:TOILLION PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:TOILLION PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:C
Authorized Official - Last Name:TOILLION
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-624-1182
Mailing Address - Street 1:418 E 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-2556
Mailing Address - Country:US
Mailing Address - Phone:509-624-1182
Mailing Address - Fax:509-624-0823
Practice Address - Street 1:418 E 30TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-2556
Practice Address - Country:US
Practice Address - Phone:509-624-1182
Practice Address - Fax:509-624-0823
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOILLION PEDIATRIC DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-23
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA47351223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5038211Medicaid