Basic Information
| Provider Information | |||||||||
| NPI: | 1851515514 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TO'OLO | ||||||||
| FirstName: | GASTON | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1048 UNION ST | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | BANGOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044018600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079455247 | ||||||||
| FaxNumber: | 2079470435 | ||||||||
| Practice Location | |||||||||
| Address1: | 1048 UNION ST | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | BANGOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044018600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079455247 | ||||||||
| FaxNumber: | 2079922154 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2007 | ||||||||
| LastUpdateDate: | 10/26/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 8397 | KY | N | Dental Providers | Dentist | 1223G0001X | 1199 | AK | N | Dental Providers | Dentist | General Practice | 1223P0221X | DEN4096 | ME | Y | Dental Providers | Dentist | Pediatric Dentistry | 122300000X | DEN4096 | ME | N | Dental Providers | Dentist | 1223G0001X | DEN4096 | ME | N | Dental Providers | Dentist | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 434387199 | 05 | ME | MEDICAID |