Provider Demographics
NPI:1477161628
Name:TOLLEFSON, ERIN (DDS)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:TOLLEFSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4710 COMMERCE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-9033
Mailing Address - Country:US
Mailing Address - Phone:715-835-0606
Mailing Address - Fax:
Practice Address - Street 1:4710 COMMERCE VALLEY RD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-9033
Practice Address - Country:US
Practice Address - Phone:715-835-0606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002355-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1002355-15OtherDENTAL LICENSE NUMBER