Provider Demographics
NPI:1508003344
Name:TOLHURST, DANIEL O (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:O
Last Name:TOLHURST
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 1:42112 WASHINGTON ST
Mailing Address - Street 2:SUITE 1F
Mailing Address - City:BERMUDA DUNES
Mailing Address - State:CA
Mailing Address - Zip Code:92203-8163
Mailing Address - Country:US
Mailing Address - Phone:760-360-9274
Mailing Address - Fax:760-345-4902
Practice Address - Street 1:42112 WASHINGTON ST
Practice Address - Street 2:SUITE 1F
Practice Address - City:BERMUDA DUNES
Practice Address - State:CA
Practice Address - Zip Code:92203-8163
Practice Address - Country:US
Practice Address - Phone:760-360-9274
Practice Address - Fax:760-345-4902
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39486122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice