Provider Demographics
NPI:1902059371
Name:TOLIVER, EDWARD C (DDS, MPH)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:C
Last Name:TOLIVER
Suffix:
Gender:M
Credentials:DDS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 E 87TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-6045
Mailing Address - Country:US
Mailing Address - Phone:773-651-0522
Mailing Address - Fax:773-651-0839
Practice Address - Street 1:536 E 87TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-6045
Practice Address - Country:US
Practice Address - Phone:773-651-0522
Practice Address - Fax:773-651-0839
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190214971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice