Provider Demographics
NPI:1174645485
Name:TOOTLE, ROBERT MARK (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MARK
Last Name:TOOTLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N COURT ST
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-1226
Mailing Address - Country:US
Mailing Address - Phone:740-477-2220
Mailing Address - Fax:740-477-1659
Practice Address - Street 1:600 N COURT ST
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-1226
Practice Address - Country:US
Practice Address - Phone:740-477-2220
Practice Address - Fax:740-477-1659
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300165051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0448411Medicaid