Provider Demographics
NPI:1568681310
Name:ROGER C. TOLLEY, D.D.S., P.C.
Entity Type:Organization
Organization Name:ROGER C. TOLLEY, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:C
Authorized Official - Last Name:TOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:610-489-2037
Mailing Address - Street 1:307 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-2604
Mailing Address - Country:US
Mailing Address - Phone:610-489-2037
Mailing Address - Fax:610-489-4598
Practice Address - Street 1:307 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-2604
Practice Address - Country:US
Practice Address - Phone:610-489-2037
Practice Address - Fax:610-489-4598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS023140L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty