Healthcare Provider Details

I. General information

NPI: 1982343679
Provider Name (Legal Business Name): TOOTH STORY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 06/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5450 KNOLL NORTH DR STE 310
COLUMBIA MD
21045-2369
US

IV. Provider business mailing address

5450 KNOLL NORTH DR STE 310
COLUMBIA MD
21045-2369
US

V. Phone/Fax

Practice location:
  • Phone: 443-545-5058
  • Fax:
Mailing address:
  • Phone: 443-545-5058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KAREN SANDOVAL
Title or Position: OFFICE MANAGER
Credential:
Phone: 443-545-5058