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General NPI Number Information
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NPI Number | 1376111997
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Entity Type | Organization
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Legal Business Name | TOOTH TOWN DENTISTRY 4 KIDS
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Dates
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Enumeration Date | 06/11/2021
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Last Update Date | 06/11/2021
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Provider Practice Location Address
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Address Line | 15990 S RANCHO SAHUARITA BLVD STE 110
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City | SAHUARITA
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State | AZ
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Zip | 85629-8022
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Country | US
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Telephone | 520-363-4774
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Fax |
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Provider Business Mailing Address
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Address Line | 13471 N TRAILING INDIGO CT
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City | TUCSON
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State | AZ
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Zip | 85755-6040
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | NATALY PENUELAS
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Credential |
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Telephone | 208-680-0186
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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 |
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License Number State |
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