Provider Demographics
NPI:1952405169
Name:G. DINO TOLIAS,D.D.S. P.C.
Entity Type:Organization
Organization Name:G. DINO TOLIAS,D.D.S. P.C.
Other - Org Name:GENTLE DENTIST-SMILE SPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:GDULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-771-1990
Mailing Address - Street 1:28503 LITTLE MACK AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1119
Mailing Address - Country:US
Mailing Address - Phone:586-771-1990
Mailing Address - Fax:586-771-9285
Practice Address - Street 1:28503 LITTLE MACK AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1119
Practice Address - Country:US
Practice Address - Phone:586-771-1990
Practice Address - Fax:586-771-9285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI111371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1828907Medicare UPIN