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General NPI Number Information
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NPI Number | 1093422040
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Entity Type | Organization
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Legal Business Name | TOOTH FAIRIES OF CALIFORNIA
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Dates
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Enumeration Date | 10/31/2022
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Last Update Date | 10/31/2022
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Provider Practice Location Address
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Address Line | 7915 LAGUNA BLVD STE 105
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City | ELK GROVE
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State | CA
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Zip | 95758-7945
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Country | US
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Telephone | 916-502-7252
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Fax |
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Provider Business Mailing Address
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Address Line | 10373 GILLIAM DR
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City | ELK GROVE
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State | CA
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Zip | 95757-3512
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Country | US
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Telephone | 916-502-7252
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MIRA YANG
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Credential |
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Telephone | 916-502-7252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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