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General NPI Number Information
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NPI Number | 1497561468
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Entity Type | Organization
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Legal Business Name | NAK TINY TEETH, PA
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Dates
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Enumeration Date | 12/05/2024
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 1614 W PLAZA DR
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City | TALLAHASSEE
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State | FL
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Zip | 32308-5324
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Country | US
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Telephone | 850-792-9100
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Fax | 850-378-5393
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Provider Business Mailing Address
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Address Line | 1614 W PLAZA DR
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City | TALLAHASSEE
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State | FL
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Zip | 32308-5324
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Country | US
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Telephone | 850-792-9100
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Fax | 850-378-5393
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Authorized Official
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Title or Position | EXECUTIVE MANAGER ACCOUNTS & CREDEN
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Name | MRS. BETH ADAMS
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Credential | RDH
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Telephone | 850-879-3605
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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