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General NPI Number Information
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NPI Number | 1386458636
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Entity Type | Organization
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Legal Business Name | TOOTH TOWN LLC
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Dates
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Enumeration Date | 02/06/2025
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 1338 N BELT HWY
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City | SAINT JOSEPH
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State | MO
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Zip | 64506-2537
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Country | US
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Telephone | 646-740-9607
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Fax |
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Provider Business Mailing Address
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Address Line | 1803 WYANDOTTE ST APT 205
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City | KANSAS CITY
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State | MO
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Zip | 64108-2553
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Country | US
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Telephone | 646-740-9607
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. ONAEDO ACHEBE
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Credential |
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Telephone | 646-740-9607
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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