Provider Demographics
NPI:1356362149
Name:TOLLEY, BARRETT ROSS (DDS)
Entity type:Individual
Prefix:
First Name:BARRETT
Middle Name:ROSS
Last Name:TOLLEY
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 1:3330 CAPITAL OAKS DR STE 1
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4513
Mailing Address - Country:US
Mailing Address - Phone:850-386-4602
Mailing Address - Fax:850-386-4206
Practice Address - Street 1:3330 CAPITAL OAKS DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4513
Practice Address - Country:US
Practice Address - Phone:850-386-4602
Practice Address - Fax:850-386-4206
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN174621223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery