Healthcare Provider Details

I. General information

NPI: 1871211672
Provider Name (Legal Business Name): TOOTH KIDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2022
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4055 W CHANDLER BLVD
CHANDLER AZ
85226-3700
US

IV. Provider business mailing address

2747 E UNIVERSITY DR. BOX #2399
MESA AZ
85213
US

V. Phone/Fax

Practice location:
  • Phone: 480-254-9566
  • Fax:
Mailing address:
  • Phone: 480-254-9566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. J ROCKWELL WRIGHT
Title or Position: CEO/ ACTIVE MANAGER
Credential: DDS
Phone: 480-254-9566