Provider Demographics
NPI:1497077986
Name:BRUCE C TOILLION
Entity Type:Organization
Organization Name:BRUCE C TOILLION
Other - Org Name:MEDICAL LAKE DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DDS
Authorized Official - Prefix:
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:509-299-5171
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:MEDICAL LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99022-0010
Mailing Address - Country:US
Mailing Address - Phone:509-299-5171
Mailing Address - Fax:509-299-5151
Practice Address - Street 1:N 123 BROWER
Practice Address - Street 2:
Practice Address - City:MEDICAL LAKE
Practice Address - State:WA
Practice Address - Zip Code:99022
Practice Address - Country:US
Practice Address - Phone:509-299-5171
Practice Address - Fax:509-299-5151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4735122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5511704Medicaid