Provider Demographics
NPI:1831313832
Name:TOLMACH, IRINA (DMD)
Entity Type:Individual
Prefix:DR
First Name:IRINA
Middle Name:
Last Name:TOLMACH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1247 BEACON ST # A
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5273
Mailing Address - Country:US
Mailing Address - Phone:617-566-5400
Mailing Address - Fax:
Practice Address - Street 1:1247 BEACON ST # A
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5273
Practice Address - Country:US
Practice Address - Phone:617-566-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA184571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0276804Medicaid