Marisa E Tolzin

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019.031722 Issued in IL

Practice address

645 Plaza Dr
Sycamore, IL 60178

Phone

(815) 895-2298

NPI assigned

Apr 22, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sycamore Family Dentistry, LTD.

  • Dentist
  • Sycamore, IL
  • NPI 1104011808
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1524355200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529280000000",
    "number": "1356838627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "645 PLAZA DR",
            "city": "SYCAMORE",
            "state": "IL",
            "postal_code": "601782719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "645 PLAZA DR",
            "city": "SYCAMORE",
            "state": "IL",
            "postal_code": "60178",
            "telephone_number": "815-895-2298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOLZIN",
        "first_name": "MARISA",
        "middle_name": "E",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-22",
        "last_updated": "2018-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.031722",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ILLINOIS STATE LICENSE",
            "identifier": "019.031722",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristin Tilton, RN, BSN, MPH
• Thomas Wayne Tilton, DO
• Timothy Tronc Counseling & Consulting LLC (Associates In Counseling)
• Tina Starkweather DPM & Assocaites, PC
• Tina Starkweather DPM & Associates PC
• Kenneth Paul TRCH, DDS
• Timothy M Tronc, MSW, LCSW
• Kimberly Trotter, LPC
• Anthony Pete Tsiftilis, O.D.
• Cynthia Ann Tucker, PT

• General Practice Dentistry in Sycamore, IL
• Providers in Sycamore, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.