Provider Demographics
NPI:1962620229
Name:DANIEL H DE TOLLA, D.D.S., M.D., PA
Entity type:Organization
Organization Name:DANIEL H DE TOLLA, D.D.S., M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:DE TOLLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:603-436-3608
Mailing Address - Street 1:200 GRIFFIN ROAD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801
Mailing Address - Country:US
Mailing Address - Phone:603-436-3608
Mailing Address - Fax:603-436-3646
Practice Address - Street 1:200 GRIFFIN ROAD
Practice Address - Street 2:SUITE 8
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801
Practice Address - Country:US
Practice Address - Phone:603-436-3608
Practice Address - Fax:603-436-3646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3472261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE8323Medicare UPIN