Provider Demographics
NPI:1871684282
Name:TOZER, JOHN EDWARD (DMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:EDWARD
Last Name:TOZER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3225
Mailing Address - Country:US
Mailing Address - Phone:207-945-5300
Mailing Address - Fax:207-942-3465
Practice Address - Street 1:743 BROADWAY
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3225
Practice Address - Country:US
Practice Address - Phone:207-945-5300
Practice Address - Fax:207-942-3465
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME30901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice