Provider Demographics
NPI:1477725786
Name:TOLSON, GINA L (RDH)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:L
Last Name:TOLSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2669 N 92ND ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1800
Mailing Address - Country:US
Mailing Address - Phone:414-258-2216
Mailing Address - Fax:414-258-9466
Practice Address - Street 1:2669 N 92ND ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-1800
Practice Address - Country:US
Practice Address - Phone:414-258-2216
Practice Address - Fax:414-258-9466
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10073-016124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI10073-016OtherSTATE LICENSE