Individual
DR. LAIF DANE TOLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
575 S WICKHAM RD STE D, W MELBOURNE, FL 32904-1170
(321) 768-0991
Mailing address
575 S WICKHAM RD STE D, W MELBOURNE, FL 32904-1170
(321) 768-0991
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
23607
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23607
DENTAL LICENSE
FL
Enumeration date
08/03/2018
Last updated
06/04/2021
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