Provider Demographics
NPI:1659535763
Name:TOLLI, JOHN JOSEPH (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JOSEPH
Last Name:TOLLI
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 1:68 MAHOPAC AVE
Mailing Address - Street 2:
Mailing Address - City:AMAWALK
Mailing Address - State:NY
Mailing Address - Zip Code:10501-1014
Mailing Address - Country:US
Mailing Address - Phone:914-962-6447
Mailing Address - Fax:
Practice Address - Street 1:68 MAHOPAC AVE
Practice Address - Street 2:
Practice Address - City:AMAWALK
Practice Address - State:NY
Practice Address - Zip Code:10501-1014
Practice Address - Country:US
Practice Address - Phone:914-962-6447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032266122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist