Individual
MARISA E TOLZIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
645 PLAZA DR, SYCAMORE, IL 60178
(815) 895-2298
Mailing address
645 PLAZA DR, SYCAMORE, IL 60178-2719
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019.031722
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019.031722
ILLINOIS STATE LICENSE
IL
Enumeration date
04/22/2018
Last updated
06/18/2018
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