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General NPI Number Information
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NPI Number | 1265815054
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Entity Type | Organization
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Legal Business Name | TOOTH TALES
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Dates
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Enumeration Date | 06/30/2015
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Last Update Date | 06/30/2015
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Provider Practice Location Address
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Address Line | 12741 MIRAMAR PARKWAY SUITE 203
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City | MIRAMAR
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State | FL
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Zip | 33027
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Country | US
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Telephone | 954-236-5273
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Fax | 954-653-2967
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Provider Business Mailing Address
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Address Line | 12741 MIRAMAR PKWY SUITE 203
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City | MIRAMAR
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State | FL
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Zip | 33027-2903
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Country | US
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Telephone | 954-236-5273
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Fax | 954-653-2967
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | TIMOTHY P CHEN
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Credential |
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Telephone | 954-236-5273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN91444
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN15943
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN16682
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License Number State | FL
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