Healthcare Provider Details

I. General information

NPI: 1689176471
Provider Name (Legal Business Name): TINY TOWN SMILES DENTISTRY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2018
Last Update Date: 03/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1466 TINY TOWN RD STE A
CLARKSVILLE TN
37042-8292
US

IV. Provider business mailing address

17000 RED HILL AVE
IRVINE CA
92614-5626
US

V. Phone/Fax

Practice location:
  • Phone: 931-548-0119
  • Fax:
Mailing address:
  • Phone: 714-845-8280
  • Fax: 303-952-0892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOAHN T TO
Title or Position: OWNER
Credential: DDS
Phone: 931-548-0119