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General NPI Number Information
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NPI Number | 1043478803
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Entity Type | Organization
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Legal Business Name | TOOTHMAN DENTAL CENTER
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Dates
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Enumeration Date | 05/29/2008
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Last Update Date | 05/29/2008
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Provider Practice Location Address
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Address Line | 801 E GREENE ST
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City | WAYNESBURG
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State | PA
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Zip | 15370-1753
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Country | US
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Telephone | 724-627-5399
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Fax | 724-627-7052
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Provider Business Mailing Address
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Address Line | 801 E GREENE ST
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City | WAYNESBURG
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State | PA
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Zip | 15370-1753
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Country | US
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Telephone | 724-627-5399
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Fax | 724-627-7052
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. INGRID K TOOTHMAN
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Credential | DMD
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Telephone | 724-627-5399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS022876L
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License Number State | PA
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