Healthcare Provider Details

I. General information

NPI: 1134083173
Provider Name (Legal Business Name): TINY TEETH PEDIATRIC DENTISTRY PA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 SECOND ST
AUBURN ME
04210-6853
US

IV. Provider business mailing address

24 CABOT DR
NASHUA NH
03064-1632
US

V. Phone/Fax

Practice location:
  • Phone: 347-743-2419
  • Fax:
Mailing address:
  • Phone:
  • 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: CHERICE LIM
Title or Position: PEDIATRIC DENTIST
Credential:
Phone: 347-743-2419