Provider Demographics
NPI:1497854897
Name:SHING-DE TOLLA, JADIE SUI WAI (DDS)
Entity Type:Individual
Prefix:
First Name:JADIE
Middle Name:SUI WAI
Last Name:SHING-DE TOLLA
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 1:329 E MAIN ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2830
Mailing Address - Country:US
Mailing Address - Phone:631-265-9616
Mailing Address - Fax:631-265-9634
Practice Address - Street 1:329 E MAIN ST
Practice Address - Street 2:SUITE 7
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2830
Practice Address - Country:US
Practice Address - Phone:631-265-9616
Practice Address - Fax:631-265-9634
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036322-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist