Provider Demographics
NPI:1417151697
Name:TOOLE, KEVIN CHASE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:CHASE
Last Name:TOOLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 E NORTHFIELD DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-2433
Mailing Address - Country:US
Mailing Address - Phone:317-432-9151
Mailing Address - Fax:
Practice Address - Street 1:480 E NORTHFIELD DR
Practice Address - Street 2:SUITE 400
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-2433
Practice Address - Country:US
Practice Address - Phone:317-432-9151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011012A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice