Provider Demographics
NPI:1548601776
Name:TOSH FAMILY DENTAL
Entity Type:Organization
Organization Name:TOSH FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RORY
Authorized Official - Last Name:TOSH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:765-482-3201
Mailing Address - Street 1:905 N LEBANON ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-1725
Mailing Address - Country:US
Mailing Address - Phone:765-482-3201
Mailing Address - Fax:765-482-3230
Practice Address - Street 1:905 N LEBANON ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-1725
Practice Address - Country:US
Practice Address - Phone:765-482-3201
Practice Address - Fax:765-482-3230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1801863592Medicaid