Provider Demographics
NPI:1588939607
Name:POOLEY, TOM L (DDS)
Entity type:Individual
Prefix:DR
First Name:TOM
Middle Name:L
Last Name:POOLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:124 E WALNUT ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-4189
Mailing Address - Country:US
Mailing Address - Phone:507-388-3384
Mailing Address - Fax:507-388-6079
Practice Address - Street 1:124 E WALNUT ST
Practice Address - Street 2:SUITE 300
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-4189
Practice Address - Country:US
Practice Address - Phone:507-388-3384
Practice Address - Fax:507-388-6079
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12049122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist