Provider Demographics
NPI:1801863592
Name:TOSH, MICHAEL RORY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RORY
Last Name:TOSH
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 1:905 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:
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:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010468122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist